Covered Services and Supplies
Medical Services and Supplies Office Visits
Office visits for services by a Physician are covered. Also covered are office visits for services by other health care professionals when you are referred by your Primary Care Physician.
Periodic Health Evaluations (including annual preventive physical examinations)
For preventive health purposes, a periodic health evaluation and diagnostic preventive procedures are
covered, based on recommendations published by the U.S. Preventive Services Task Force. In addition, a covered annual cervical cancer screening test includes a Pap test, a human papillomavirus (HPV) screening test that is approved by the federal Food and Drug Administration (FDA), and the option of any cervical cancer screening test approved by the FDA. Coverage includes annual preventive physical examinations as directed by Your Physician, or as otherwise medically indicated.
Vision and Hearing Examinations
Eye and ear examinations to determine the need for correction of vision and hearing are covered. Vision and hearing screenings, provided as part of a periodic health evaluation, are covered at no charge.
Standard hearing devices (analog or digital) inserted in or affixed to the outer ear to restore adequate
hearing to the Member and are determined to be Medically Necessary are covered. This includes repair and maintenance (but not replacement batteries).
Obstetrician and Gynecologist (OB/GYN) Self-Referral
If you are a female Member you may obtain OB/GYN Physician services without first contacting your Primary Care Physician.
If you need OB/GYN preventive care, are pregnant or have a gynecology ailment, you may go directly to an OB/GYN Specialist or a Physician who provides such services in your Physician Group.
If such services are not available in your Physician Group, you may go to one of the contracting
Physician Group’s referral Physicians who provides OB/GYN services. (Each contracting Physician
Group can identify its referral Physicians.)
The OB/GYN Physician will consult with the Member’s Primary Care Physician regarding the
Member’s condition, treatment and any need for Follow-Up Care.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Procedure code and description 95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory air...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...