June 2, 2006

 

 

 

 

 

TO:                 All Physicians, Osteopaths and Mid-Level Practitioners

 

FROM:           Leslie M. Clement, Deputy Administrator

 

 

Idaho Medicaid has updated rates and age limitations for EPSDT and Adult Preventive Medicine procedure codes, in support of the Medicaid Modernization Initiative.  Rates for existing EPSDT preventive medicine codes were increased, and additional adult preventive medicine codes became payable to cover well examinations for all Idaho Medicaid participants.  (Prior to July 1, 2006, preventive medicine procedures were only covered for participants up to the age of 21.)

 

 

Updated reimbursement rates are listed in the table below.  Additionally, the age limitation for codes 99385 and 99395 have been updated to cover adult participants ages 18-39. 

 

 

 

The following codes are effective July 1, 2006 to cover well examinations for adult participants over age 39:

 

 

 

*Preventive Medicine procedures billed for participants over age 21 must be billed with diagnosis code V700 or the claim will be denied. Please bill the appropriate procedure for the participant’s age as listed above.  

 

Adult preventive medicine procedures will be limited to one per rolling year. Evaluation and Management procedures will not be paid on the same day as a preventive medicine procedure for participants over age 21.

 

If you have any questions please contact Eric Anderson, Senior Financial Specialist for the Medicaid Office of Reimbursement Policy, at (208) 364-1918.  Thank you for your continued participation in the Idaho Medicaid program.

 

LC/ea/sw