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MERIDIAN PROVIDER REWARDS FOR WOMEN'S HEALTHCARE

Date: 10/10/23

Increase your practice’s efficiency in closing HEDIS® care gaps and receiving provider incentives by using accurate claims coding.

Various codes can be utilized when billing for rendered services. We have created a summary of billing codes for postpartum care (PPC), breast cancer screening (BCS), cervical cancer screening (CCS), and HPV tests.

 

Postpartum care (PPC) incentive: Target 1—$15, Target 2—$30

Use these codes for postpartum services rendered for PPC measures.


• CPT: 57170, 58300, 59430, 99501
• CPT-CAT-II: 0503F
• ICD-10: Z01.411, Z01.419, Z01.42, Z30.430, Z39.1, Z39.2
• HCPCS: G0101

 

Breast cancer screening (BCS) incentive: Target 1—$20, Target 2—$40

Use these codes for mammogram breast cancer screening services for the BCS measure.


• CPT: 77061-77063, 77065-77067
• HCPCS: G0202, G0204, G0206
• SNOMED CT: 12389009, 24623002, 43204002, 71651007, 241055006, 241057003, 241058008, 258172002, 439324009, 450566007, 709657006, 723778004, 723779007, 723780005, 726551006, 833310007, 866234000, 866235004, 866236003, 866237007, 384151000119104, 392521000119107, 392531000119105, 566571000119105, 572701000119102
• LOINC: 24604-1, 24605-8, 24606-6, 24610-8, 26175-0, 26176-8, 26177-6, 26287-3, 26289-9, 26291-5, 26346-7, 26347-5, 26348-3, 26349-1, 26350-9, 26351-7, 36319-2, 36625-2, 36626-0, 36627-8, 36642-7, 36962-9, 37005-6, 37006-4, 37016-3, 37017-1, 37028-8, 37029-6, 37030-4, 37037-9, 37038-7, 37052-8, 37053-6, 37539-4, 37542-8, 37543-6, 37551-9, 37552-7, 37553-5, 37554-3, 37768-9, 37769-7, 37770-5, 37771-3, 37772-1, 37773-9, 37774-7, 37775-4, 38070-9, 38071-7, 38072-5, 38090-7, 38091-5, 38807-4, 38820-7, 38854-6, 38855-3, 39150-8, 39152-4, 39153-2, 39154-0, 42168-5, 42169-3, 42174-3, 42415-0, 42416-8, 46335-6, 46336-4, 46337-2, 46338-0, 46339-8, 46342-2, 46350-5, 46351-3, 46354-7, 46355-4, 46356-2, 46380-2, 48475-8, 48492-3, 69150-1, 69251-7, 69259-0, 72137-3, 72138-1, 72139-9, 72140-7, 72141-5, 72142-3, 86462-9, 86463-7, 91517-3, 91518-1, 91519-9, 91520-7, 91521-5, 91522-3

 

Cervical cancer screening (CCS) incentive: Target 1—$20, Target 2—$40

Use these codes for women screened for cervical cancer for the CCS measure.


Cervical cytology
• CPT: 88141-88143, 88147, 88148,88150, 88152-88153, 88164-88167,88174, 88175
• HCPCS: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091


HPV tests (ages 30-64)
• CPT: 87624, 87625
• HCPCS: G0476