Billing Codes
Your patient’s insurance plan may cover these services 100%–with no co-pays or deductibles for your patient to pay. Many insurers require the clinical provider to code the services in particular ways that often vary by insurer. Diagnosis codes may be required for proper reimbursement for some services. This is not intended to be a comprehensive list, and not all insurers accept all of these coding configurations. For more guidance check with your patient’s insurer and review information from Medicare Cdc-pdf[105KB, 1 page]External, CIGNA Cdc-pdf[123 KB, 12 pages]External, UnitedHealthcareCdc-pdfExternal, and AAP (Bright FuturesCdc-pdfExternal and Printable 2012 VersionExternal).
Common Services
Wellness Examinations (well baby, well child, well adult)
Procedure codes: 99201-99205, 99211-99215, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99461, G0101, G0344, G0402, G0438, G0439, G0445, S0610, S0612, S0613
ICD-9: V03.0-V06.9, V20.0-V20.2, V20.31-V20.32, V70.0, V24.2, V72.3, V72.31, V76.2, V76.46, V76.47, V84.02, V84.04
Abdominal Aortic Aneurysm Screening
Procedure codes: 76700, 76705, 76770, 76775, G0389
ICD-9: V15.82
ICD-10: Z87.891, F17.210, F17.211, F17.213, F17.218, F17.219
Alcohol Misuse
Procedure codes: 99401-99404, 99408, 99409, 99411, 99412, G0396, G0397, G0442
ICD-9: V65.42, V65.49, V79.1
Anemia, Iron Deficiency Anemia Screening
Procedure codes: 36415, 36416, 85013, 85014, 85041, 85018
ICD-9: Pregnancy Diagnosis Codes
Bacteriuria Screening
Procedure codes: 81007
ICD-9: Pregnancy Diagnosis Codes
Behavioral Counseling to Prevent Sexually Transmitted Infections
Procedure codes: 99401-99404, G0445
Breastfeeding Support, Supplies, and Counseling
Procedure codes: 99201-99203, 99211-99214, 99241-99245, 99341-99345, 99347-99350, 99401-99404, 99411-99412, A4281-A4286, E0602-E0604, S9443
ICD-9: V24.1
ICD-10: Z39.1
Cervical Cancer
Procedure codes: 88141-88143, 88147, 88148, 88150, 88152-88155, 88164-88167, 88174, 88175, G0101, G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091
ICD-9: V70.0, V72.31, V72.32, V76.2
ICD-10: Z00.00, Z01.419, Z12.4
Chemoprevention of Breast Cancer
Procedure codes: 99201-99205, 99211-99215, 99385-99387, 99395-99397
ICD-9: V16.3, V16.41
ICD-10: Z80.3, Z80.41, Z15.01, Z15.02
Chlamydia Infection Screening
Procedure codes: 36415, 36416, 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87801, 87810, G0450
ICD-9: V70.0, V73.88, V73.98, V74.5, V75.9 OR Pregnancy Diagnosis Codes
ICD-10: Z00.00, Z11.3, Z11.8, Z11.9, Z20.2 OR Pregnancy Diagnosis Codes
Cholesterol Screening
Procedure codes: 36415, 36416, 80061, 82465, 83718, 83719, 83721, 84478
ICD-9: V70.0 or V77.91, Hypertension Diagnosis Codes, Diabetes Diagnosis Codes
ICD-10: Z00.00, Z13.220, Hypertension Diagnosis Codes, Diabetes Diagnosis Codes
Colorectal Cancer Screening
Procedure codes: 44388, 44389, 44392-44394, 45300-45320, 45330-45335, 45338-45340, 45378-45386, 74263, 82270, 82274, 88304, 88305, G0104-G0107, G0120-G0122, G0328, G0394, S0601, S3890
ICD-9: V16.0, V18.51, V18.59, V70.0, V72.62, V76.41, V76.50, V76.51
ICD-10: Z00.00, Z12.10, Z12.11, Z12.12, Z80.0, Z83.71, Z83.79
Depression
Procedure codes: 99420, G0444
ICD-9: V79.0
ICD-10: Z13.89
Diabetes Screening
Procedure codes: 36415, 36416, 82947, 82948, 82950-82952, 83036
ICD-9: V70.0 or V77.1 AND Hypertension Diagnosis Codes
ICD-10: Z00.00, Z13.1 AND Hypertension Diagnosis Codes
Genetic Counseling and Evaluation for BRCA Testing
Procedure codes: 96040, 99201-99205, 99211-99215, 99385-99387, 99395-99397, S0265
ICD-9: V10.3, V10.43, V16.3, V16.41
ICD-10: Z80.3, Z80.41, Z85.3, Z85.43, Z15.01, Z15.02
Gonorrhea Screening
Procedure codes: 87590, 87591, 87592, 87801, 87850, G0450
ICD-9: V70.0, V74.5, V75.9 OR Pregnancy Diagnosis Codes
ICD-10: Z00.00, Z11.3, Z11.9, Z20.2 OR Pregnancy Diagnosis Codes
Healthy Diet/Obesity Counseling
Procedure codes: 97802-97804, 99401-99404, 99411, 99412, G0270, G0271, G0446, G0447, G0449, S9470
ICD-9: Hypertension Diagnosis Codes, Diabetes Diagnosis Codes
ICD-10: Hypertension Diagnosis Codes, Diabetes Diagnosis Codes
Hepatitis B Virus Infection Screening
Procedure codes: 36415, 36416, 87340, 87341
ICD-9: Pregnancy Diagnosis Codes
ICD-10: Pregnancy Diagnosis Codes
Hepatitis C Screening
Procedure codes: 86803, 86804
ICD-9: V20.0-V20.2, V22-V24.2, V70.0, V72.3, V72.31, V72.62
HIV Screening
Procedure codes: 36415, 36416, 86689, 86701-86703, 87390, 87391, G0432, G0433, G0435, S3645
ICD-9: V02.9, V20.0-V20.2, V70.0, V72.3, V72.31, V72.62, V73.89, V74.5, V75.9 OR Pregnancy Diagnosis Codes
ICD-10: Z00.00, Z22.6, Z22.8, Z22.9, Z11.3, Z11.4, Z11.59, Z11.9, Z20.6 OR Pregnancy Diagnosis Codes
Human Papillomavirus DNA Testing
Procedure codes: 87620-87622
ICD-9: V24.2, V70.0, V72.3, V72.31,V72.6, V72.60, V72.62, V73.81, V76.2, V76.46, V76.47, V84.02, V84.04
ICD-10: Z00.00, Z01.419, Z11.51, Z12.4
Newborn Metabolic and Hemoglobinopathy Screening
Procedure codes: 36415, 36416, 80047, 80048, 80053, 82017, 82136, 82261, 82775, 83020, 83498, 83516, 84030, 84437, 84443, S3620
ICD-9: V20.0-V20.2, V70.0, V72.3, V72.31, V72.62, V76.51
Osteoporosis Screening
Procedure codes: 76070, 76071, 76075, 76076, 76078, 76977, 77078, 77080, 77081, 77083, 78350, G0130
ICD-9: V17.81, V49.81, V70.0, V72.0, V72.3, V72.31, V82.81
ICD-10: Z00.00, Z13.820, Z82.62
RH Incompatibility Screening
Procedure codes: 36415, 36416, 86900, 86901
ICD-9: Pregnancy Diagnosis Codes
ICD-10: Pregnancy Diagnosis Codes
Screening for Gestational Diabetes
Procedure codes: 36415, 36416, 82947, 82948, 82950-82952, 83036
Screening for Obesity
Procedure codes: 97802-97804, 99401-99404, G0446, G0447
ICD-9: V85.30, V85.31, V85.32, V85.33, V85.34, V85.35, V85.36, V85.37, V85.38, V85.39, V85.41, V85.42, V85.43, V85.44, V85.45, 278.00, 278.01
ICD-10: Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44, Z68.45, E66.01, E66.09, E66.1, E66.8, E66.9
Screening Mammography
Procedure codes: 77052, 77057, G0202
Syphilis Screening
36415, 36416, 86592, 86593, G0450
V70.0, V74.5, V74.9, V75.9 OR Pregnancy Diagnosis Codes
Z00.00, Z11.2, Z11.3, Z11.9, Z20.2 OR Pregnancy Diagnosis Codes
Tobacco Counseling and Interventions
Procedure codes: 99401-99404, 99406, 99407, C9801, C9802, G0436, G0437, S9075, S9453
CHILDREN
Anemia Screening in Children
Procedure codes: 36415, 36416, 85014, 85018
ICD-9: V20.2, V20.31, V20.32, V78.0
ICD-10: Z00.110, Z00.111, Z00.129, Z13.0
Developmental/Autism Screening (Bright Futures)
Procedure codes: 96110, G0451
ICD-9: V20.0-V20.2, V70.0
ICD-10: Z00.129, Z13.4
Dyslipidemia Screening (Bright Futures)
Procedure codes: 36415, 36416, 80061, 82465, 83718, 83719, 83721, 84478
ICD-9: V20.2, V77.91
ICD-10: Z00.129, Z13.220
Hearing Tests (Bright Futures)
Procedure codes: 92551- 92553
ICD-9: V20.2, V72.19
ICD-10: Z00.129, Z01.10
Lead Screening (Bright Futures)
Procedure codes: 36415, 36416, 83655
ICD-9: V20.2, V15.86
ICD-10: Z00.129, Z77.011
Newborn Hearing Screening:
Procedure codes: 92551, 92558, 92585-92588, V5008
ICD-9: V20.31, V20.32
Newborn Blood Spot Screening:
Procedure codes: 36415, 36416, 83020, 83021, 83030, 83033, 83051, 84030, 84437, 84443, S3620, S3850
Screening for Visual Impairment in Children
Procedure codes: 99173, 99174
ICD-9: V03.0-V03.9, V04.0-V04.89, V05.0-V05.9, V06.0-V06.9, V20.0-V20.2, V70.0, V72.0, V72.3, V72.31, 367.0-367.4
TB Testing (Bright Futures)
Procedure codes: 86580, 99211
ICD-9: 795.51, 795.52, V20.2, V74.1
ICD-10: R76.11, R76.12, Z00.129, Z111
IMMUNIZATIONS
Immunization Administration:
Procedure codes: 90460, 90461, 90465-90468, 90470-90474, G0008-G0010, G0377, G9141, J3530
Dtap / Dtpap‐IPV, Dtap‐Hib‐IPV / DTP / DT / Tetanus / Polio / TdaP/ Measles, Mumps, Rubella /MMR:
Procedure codes: 90696, 90698, 90700-90708, 90710, 90712-90715, 90718-90721, 90723
Hemophilus influenza b: HibTITER® PedvaxHIB®, ActHIB®
Procedure codes: 90645-90648
Hepatitis A: Havrix®,VAQTA®,Twinrix®
Procedure codes: 90632-90634, 90636
Hepatitis B: RECOMBIVAXHB® Engerix‐B®
Procedure codes: 90740, 90743, 90744, 90746-90748
HPV:
Procedure codes: 90649 (Gardasil®) 90650 (Cervarix®)
Influenza virus (‘flu’): Afluria® Fluarix® Fluvirin® Fluzone® High‐Dose Fluzone® FluLaval® FluMist®, Flublok®
Procedure codes: 90653-90658, 90660-90662, 90664, 90666-90668, 90672, 90685-90688, Q2033-Q2039
Meningococcal: Menomune® Menactra®
Procedure codes: 90644, 90733, 90734
Pneumococcal conjugate: Prevnar® Prevnar13®
Procedure codes: 90669, 90670, S0195
Pneumococcal: PNEUMOVAX®
Procedure codes: 90669, 90670, 90732, S0195
Rotavirus: ROTATEQ® Rotarix®
Procedure codes: 90680, 90681
Varicella (‘chicken pox’) Varivax®:
Procedure codes: 90716
Zoster/Shingles: Zostavax®
Procedure codes: 90736
CONTRACEPTIVE METHODS
Administration for Contraceptive Injections:
Procedure codes: 96372
Anesthesia for Sterilization:
Procedure codes: 00851, 00940, 00942, 00950, 00952, 01960, 01961, 01965-01968
ICD-9: V25.2
ICD-10: Z30.2
Contraceptive Management:
ICD-9: V25.01, V25.02, V25.03, V25.09, V25.11, V25.12, V25.13, V25.40, V25.41, V25.42, V25.43, V25.49, V25.5, V25.8, V25.9
ICD-10: Z30.011, Z30.012, Z30.013, Z30.014, Z30.018, Z30.019, Z30.09, Z30.40, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30.49, Z30.8, Z30.9
Diaphragm or cervical cap:
Procedure codes: 57170, A4261, A4266
Implantable devices & IUDs:
Procedure codes: 11976, 11981-11983, 58300, 58301, J7302, J7306, J7307, S4981, S4989, J7300, Q0090
Injections:
Procedure codes: J1050, J1051, J1055, J1056
Tubal Ligation, oviduct occlusion:
Procedure codes: 58340, 58565, 58600, 58605, 58611, 58615, 58670, 58671, 74740, A4264
DIABETES DIAGNOSIS CODE LIST
ICD-9:
Secondary Diabetes Mellitus: 249.00, 249.01, 249.10, 249.11, 249.20, 249.21, 249.30, 249.31, 249.40, 249.41, 249.50, 249.51, 249.60, 249.61, 249.70, 249.71, 249.80, 249.81, 249.90, 249.91
Diabetes Mellitus: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93
ICD-10:
Diabetes mellitus due to underlying condition: E08.00, E08.01, E08.10, E08.11, E08.21, E08.22, E08.29, E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E08.36, E08.39, E08.40, E08.41, E08.42, E08.43, E08.44, E08.49, E08.51, E08.52, E08.59, E08.610, E08.618, E08.620, E08.621, E08.622, E08.628, E08.630, E08.638, E08.641, E08.649, E08.65, E08.69, E08.8, E08.9
Drug or chemical induced diabetes mellitus: E09.00, E09.01, E09.10, E09.11, E09.21, E09.22, E09.29, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E09.36, E09.39, E09.40, E09.41, E09.42, E09.43, E09.44, E09.49, E09.51, E09.52, E09.59, E09.610, E09.618, E09.620, E09.621, E09.622, E09.628, E09.630, E09.638, E09.641, E09.649, E09.65, E09.69, E09.8, E09.9
Type 1 diabetes mellitus: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628
Type 2 diabetes mellitus: E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9
Other specified diabetes mellitus: E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359, E13.36, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9
HYPERTENSION DIAGNOSIS CODE LIST
Essential Hypertension:
ICD-9: 401.0, 401.1, 401.9
ICD-10: I10
Hypertensive Heart Disease:
ICD-9: 402.00, 402.01, 402.10, 402.11, 402.90, 402.91
ICD-10: I11.0, I11.9
Hypertensive Chronic Kidney Disease:
ICD-9: 403.00, 403.01, 403.10, 403.11, 403.90, 403.91
ICD-10: I12.0, I12.9
Hypertensive Heart and Chronic Kidney Disease:
ICD-9: 404.00, 404.01, 404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93 ICD-10: I13.0, I13.10, I13.11, I13.2 Secondary Hypertension: ICD-9: 405.01, 405.09, 405.11, 405.19, 405.91, 405.99
ICD-10: I15.0, I15.1, I15.2, I15.8, I15.9, N26.2
Hypertension Complicating Pregnancy, Childbirth and the Puerperium:
ICD-9: 642.01, 642.03, 642.04, 642.11, 642.13, 642.14, 642.21, 642.23, 642.24, 642.30, 642.31, 642.33, 642.34, 642.91, 642.93, 642.94
ICD-10: O10.011, O10.012, O10.013, O10.019, O10.02, O10.03, O10.111, O10.112, O10.113, O10.119, O10.12, O10.13, O10.211, O10.212, O10.213, O10.219, O10.22, O10.23, O10.311, O10.312, O10.313, O10.319, O10.32, O10.33, O10.411, O10.412, O10.413, O10.419, O10.42, O10.43, O10.911, O10.912, O10.913, O10.919, O10.92, O10.93, O11.1, O11.2, O11.3, O11.9, O13.1, O13.2, O13.3, O13.9, O16.1, O16.2, O16.3, O16.9
PREGNANCY DIAGNOSIS CODE LIST
ICD-9: V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.87, V23.89, V23.9, V91.00, V91.01, V91.02, V91.03, V91.09, V91.10, V91.11, V91.12, V91.19, V91.20, V91.21, V91.22, V91.29, V91.90, V91.91, V91.92, V91.99
ICD-10: Z33.1, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z36, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.211, O09.212, O09.213, O09.219, O09.291, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.40, O09.41, O09.42, O09.43, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.70, O09.71, O09.72, O09.73, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93, O36.80X0, O36.80X1, O36.80X2, O36.80X3, O36.80X4, O36.80X5, O36.80X9, O30.001, O30.002, O30.003, O30.009, O30.011, O30.012, O30.013, O30.019, O30.021, O30.022, O30.023, O30.031, O30.032, O30.033, O30.039, O30.041, O30.042, O30.043, O30.049, O30.091, O30.092, O30.093, O30.099, O30.101, O30.102, O30.103, O30.109, O30.111, O30.112, O30.113, O30.119, O30.121, O30.122, O30.123, O30.129, O30.191, O30.192, O30.193, O30.199, O30.201, O30.202, O30.203, O30.209, O30.211, O30.212, O30.213, O30.219, O30.221, O30.222, O30.223, O30.229, O30.291, O30.292, O30.293, O30.299, O30.801, O30.802, O30.803, O30.809, O30.811, O30.812, O30.813, O30.819, O30.821, O30.822, O30.823, O30.829, O30.891, O30.892, O30.893, O30.899, O30.90, O30.91, O30.92, O30.93