Program for 2012
Posted 04/19/12

is designed to help members identify their health risks in an effort to improve their health. After members complete the requirements of the program, they will know what they need to do to reduce their risks and improve their health. The program is available to all primary, HealthChoice health plan members age 20 and older who are not enrolled in a HealthChoice Medicare Supplement Plan.

The educational materials provided to members include a packet the member can bring with them to their appointment. The packet contains the following:

• Provider instructions which include the preventive services the member must obtain and code specific billing instructions
• Step-by-step directions to assist the member with successfully completing the program
• An information sheet for the member to record the clinical data they will need to complete their health risk assessment (HRA)
• Questions and Answers addressing many aspects of the program, HRA completion, and the incentive payment

The following services are available once per calendar year to qualified members and are reimbursed at 100% of Allowed Charges with no copays or out-of-pocket costs to members when using a Network Provider. These services do not have to be performed on the same date.

Please use the following CPT Codes when billing for these free services:

• Initial Comprehensive Preventive Medicine
  • 99385 – new patient age 18-39, or
  • 99386 – new patient age 40-64, or
  • 99387 – new patient age 65 and older (non-Medicare)
• Periodic Comprehensive Preventive Medicine
  • 99395 – established patient age 18-39, or
  • 99396 – established patient age 40-64, or
  • 99397 – established patient age 65 and older (non-Medicare)
• Metabolic Panel
  • 80053 – comprehensive metabolic panel, or
  • 80050 – general health panel
• Lipid Panel
  • 80061 – comprehensive lipid panel

Certain other office visit codes also qualify for the program. These codes and any additional services provided outside the program are subject to all Plan provisions including copays, deductibles, and coinsurance. CPT Codes are subject to change.

Your patient needs the following information to complete the program:

• Height/weight
• Blood pressure (systolic/diastolic)
• Resting heart rate/pulse
• Fasting blood glucose
• LDL cholesterol
• HDL cholesterol
• Total cholesterol
• Triglycerides
• Tobacco usage