I'm a provider

As part of our continued commitment to a healthier Mississippi, we are expanding the benefits covered under the Healthy You! program, based on age and gender guidelines, to include a bone mineral density screening, a vaccine for shingles and an additional vaccine for the human papilloma virus (HPV). These expanded benefits will be effective January 1, 2010. Please see below for details:

1. A bone mineral density screening will be covered once per lifetime for women 50 years and older. Bone density screenings will not be covered under Healthy You! for males, regardless of age. Please see the applicable Healthy You! coding information below:

    

   • CPT Code:
     • 77080 - Dual-energy x-ray absorptiometry

      

   • ICD-9-CM Diagnosis Code:
     • V82.81 - Screening for osteoporosis

   Please click here for the Blue Cross & Blue Shield of Mississippi Bone Mineral Density Studies Medical Policy.

    

2. The Zostavax vaccine for shingles will be covered once per lifetime for members 60 years and older. Please see the applicable Healthy You! coding information below:

    

   • CPT Code:
     • 90736 - Zoster (shingles) vaccine, live, for subcutaneous injection

      

   • ICD-9-CM Diagnosis Code:
     • V04.89 - Need for prophylactic vaccination, other viral diseases

    

3. The Cervarix vaccine is being added for HPV once per lifetime for females ages 10-25 years old.  Please see the applicable Healthy You! coding information below:

    

   • CPT Codes:
     • 90649 - Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use (includes Gardasil)
     • 90650 - Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use (includes Cervarix)

      

   • ICD-9-CM Diagnosis Code:
     • V04.89 - Need for prophylactic vaccination, other viral diseases

    

4. Gardasil will continue to be covered for females only, ages 9-26 years old.

Note: HPV testing is not covered under the Healthy You! Program.  HPV testing is only covered under the patient's medical benefits following an abnormal pap smear. 

Healthy You! Medical Necessity

Effective February 1, 2010, any services billed as wellness services outside of the Healthy You! Wellness Procedures Coding Guidelines specific to age and gender will be denied as not medically necessary wellness procedures. Healthy You! is a wellness benefit that provides an annual wellness visit with a primary care network provider.  The benefit includes only wellness services outlined within certain age and gender coding guidelines.  Services provided outside of the Healthy You! Wellness Procedures Coding Guidelines will be denied as not medically necessary; therefore, you may not bill the patient for these denied charges.

In rare circumstances when a service must be provided related to an illness during a Healthy You! exam, you must code this additional service with the appropriate illness diagnosis on the claim.  Additionally, fully documented medical records are required to support the use of the illness diagnosis.

Please click here for the Blue Cross & Blue Shield of Mississippi Healthy You! Wellness Procedures Medical Policy.