Covered HealthCheck screening services are identified by the allowable procedures codes listed in the following tables.
New Patient |
||
|---|---|---|
Code |
Description |
Allowable Modifier |
99381 |
Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year) |
UA |
99382 |
early childhood (age 1 through 4 years) |
UA |
99383 |
late childhood (age 5 through 11 years) |
UA |
99384 |
adolescent (age 12 through 17 years) |
UA |
99385 |
18-(20) years |
UA |
Established Patient |
||
|---|---|---|
Code |
Description |
Allowable Modifier |
99391 |
Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) |
UA |
99392 |
early childhood (age 1 through 4 years) |
UA |
99393 |
late childhood (age 5 through 11 years) |
UA |
99394 |
adolescent (age 12 through 17 years) |
UA |
99395 |
18-(20) years |
UA |
Interperiodic Visits |
||
|---|---|---|
Code |
Description |
Allowable Modifier |
99211 |
Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional (5 minutes) |
EP |
99212 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making (10 minutes) |
EP |
99213 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity (15 minutes) |
EP |
99214 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity (25 minutes) |
EP |
99215 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components: a comprehensive history; a comprehensive examination; medical decision making of high complexity (40 minutes) |
EP |
Lead Inspection Services |
||
|---|---|---|
Code |
Description |
Allowable Modifier |
T1002 |
Registered nurse services, up to 15 minutes |
|
T1029 |
Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling |
TS |
|
Immunizations |
|
|---|---|
| Code | Description |
| 906321 | Hepatitis A vaccine, adult dosage, for intramuscular use |
| 906331 | Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use |
| 906361 | Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use |
| 906441 | Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use |
| 906471 | Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use |
| 906481 | Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use |
| 906491 | Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use |
| 906501 | Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use |
| 906551 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 ml dosage, for intramuscular use |
| 906561 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 ml dosage, for intramuscular use |
| 906571 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 ml dosage, for intramuscular use |
| 906581 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 ml dosage, for intramuscular use |
| 906601 | Influenza virus vaccine, trivalent, live, for intranasal use |
| 90661 | Influenza virus vaccine, trivalent (CCIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 ml dosage, for intramuscular use |
| 906701 | Pneumococcal conjugate vaccine, 13 valent, for intramuscular use |
| 906721 | Influenza virus vaccine, quadrivalent, live, for intranasal use |
| 90673 | Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use |
| 906801 | Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use |
| 906811 | Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use |
| 906851 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 ml dosage, for intramuscular use |
| 906861 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 ml dosage, for intramuscular use |
| 906881 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 ml dosage, for intramuscular use |
| 906961 | Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated, (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use |
| 906981 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP-Hib-IPV), for intramuscular use |
| 907001 | Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use |
| 907021 | Diphtheria and tetanus toxoids (DT) adsorbed when administered to individuals younger than 7 years, for intramuscular use |
| 907071 | Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use |
| 907101 | Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use |
| 907131 | Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use |
| 907141 | Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use |
| 907151 | Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use |
| 907161 | Varicella virus vaccine, live, for subcutaneous use |
| 907231 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use |
| 907321 | Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use |
| 907341 | Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 or Men ACWY), for intramuscular use |
| 90740 | Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use |
| 907431 | Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use |
| 907441 | Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use |
| 907461 | Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use |
| 90747 | Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use |
| 907481 | Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use |
| 90749 | Unlisted vaccine/toxoid |
|
Laboratory Tests |
|
|---|---|
| Code | Description |
| 810022 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy |
| 824653 | Cholesterol, serum or whole blood, total |
| 829473 | Glucose; quantitative, blood, (except reagent strip) |
| 850132 | Blood count; spun microhematocrit |
| 850182 | hemoglobin (Hgb) |
| 99000 | Handling and/or conveyance of specimen for transfer from the office to a laboratory |
|
Other Tests |
|
|---|---|
| Code | Description |
| 86580 | Skin test; tuberculosis, intradermal |
1Vaccine is provided through the VFC Program. Procedure codes for vaccines available through the VFC Program are subject to change. Providers should refer to the VFC Web site for a complete list of vaccines available through the VFC Program.
2Service may be performed by HealthCheck agencies with an
approved CLIA waiver.
3Service may only be performed for high-risk children and requires
appropriate follow-up.