PA Lookup
If you have questions about prior authorizations, please call:
Member and Recipient Service Line: 1-877-685-2415
Provider Support Service Line: 1-855-250-1539
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Adult Preventive Medicine Clinical Coverage Policy No.: 1A-2 Annual Health Assessment
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
Medicaid beneficiaries 21 years of age and older may receive one annual health assessment per 365 days.
The annual health assessment is not included in the legislated 22-visit limit per year.
Injectable medications and ancillary studies for laboratory and radiology are the only CPT codes that are separately billable when an annual health assessment is billed.
An annual health assessment and an office visit cannot be billed on the same date of service.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
Place of Service
Outpatient, Clinic.
How to Submit
N/A - No authorization is required
Resources
Transcranial Doppler Studies
Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
TCD studies are limited to one procedure per date of service by the same or different provider.
- a. Technical or professional components of TCD studies cannot to be billed on the same
date of service by the same or different provider as the complete procedure.
- b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be
billed separately when performed during a surgical session
Place of Service
Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Adult Preventive Medicine Clinical Coverage Policy No.: 1A-2 Annual Health Assessment
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
Medicaid beneficiaries 21 years of age and older may receive one annual health assessment per 365 days.
The annual health assessment is not included in the legislated 22-visit limit per year.
Injectable medications and ancillary studies for laboratory and radiology are the only CPT codes that are separately billable when an annual health assessment is billed.
An annual health assessment and an office visit cannot be billed on the same date of service.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
Place of Service
Outpatient, Clinic.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Adult Preventive Medicine Clinical Coverage Policy No.: 1A-2 Annual Health Assessment
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
Medicaid beneficiaries 21 years of age and older may receive one annual health assessment per 365 days.
The annual health assessment is not included in the legislated 22-visit limit per year.
Injectable medications and ancillary studies for laboratory and radiology are the only CPT codes that are separately billable when an annual health assessment is billed.
An annual health assessment and an office visit cannot be billed on the same date of service.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
Place of Service
Outpatient, Clinic.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Adult Preventive Medicine Clinical Coverage Policy No.: 1A-2 Annual Health Assessment
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
Medicaid beneficiaries 21 years of age and older may receive one annual health assessment per 365 days.
The annual health assessment is not included in the legislated 22-visit limit per year.
Injectable medications and ancillary studies for laboratory and radiology are the only CPT codes that are separately billable when an annual health assessment is billed.
An annual health assessment and an office visit cannot be billed on the same date of service.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
Place of Service
Outpatient, Clinic.
How to Submit
N/A - No authorization is required
Resources
1E-7 Family Planning Services
Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
FP Medicaid beneficiaries are limited to either one comprehensive preventive medicine evaluation or one annual assessment evaluation per 365 calendar days.
A comprehensive preventive medicine evaluation may be performed only if the beneficiary has not been seen in the previous 365 days.
If the beneficiary had an annual assessment, a comprehensive preventive medicine evaluation, or a postpartum exam in the previous 365 days, another comprehensive evaluation is not required before receiving Family Planning services.
FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.
One urinalysis and one blood count procedure code are allowed per 365 calendar days in conjunction with this service.
Exclusions
No claim is filed if, before any service is rendered, the beneficiary confirms they have been sterilized, are post-menopausal, or are otherwise incapable of conceiving or fathering a child; the visit must stop and the beneficiary is informed they are not eligible for Family Planning Medicaid services. Nurse visits billed with CPT code 99211 cannot be submitted on the same date of service as a comprehensive preventive medicine evaluation by a physician or advanced practice practitioner; total time must be combined into one evaluation and management code. Hospital emergency room or emergency department services are not covered for FP Medicaid beneficiaries, and inpatient hospital services are not covered. FP Medicaid also does not cover treatment for acute or chronic conditions discovered during screening, or services for beneficiaries who have been sterilized or no longer have a need for family planning services.
Place of Service
Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.
Additional Service Specifics
FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.
How to Submit
N/A - No authorization is required
Resources
Adult Preventive Medicine Clinical Coverage Policy No.: 1A-2 Annual Health Assessment
An adult preventive medicine health assessment consists of a comprehensive unclothed physical examination, comprehensive health history, anticipatory guidance/risk factor reduction interventions, and the ordering of gender- and age-appropriate laboratory and diagnostic procedures.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
Medicaid beneficiaries 21 years of age and older may receive one annual health assessment per 365 days.
The annual health assessment is not included in the legislated 22-visit limit per year.
Injectable medications and ancillary studies for laboratory and radiology are the only CPT codes that are separately billable when an annual health assessment is billed.
An annual health assessment and an office visit cannot be billed on the same date of service.
Age Group Details
Covered for Medicaid beneficiaries 21 years of age and older
Place of Service
Outpatient, Clinic.
How to Submit
N/A - No authorization is required
Resources
99406 25 - smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes ;significant, separately identifiable Evaluation & Management (E/M) service by the same provider on the same day as a procedure
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
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