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Network OB-Gyn Providers can continue to provide Women’s Health Services related to Wellness. This option would be designated Women’s Health and would allow existing Network Ob-Gyn Providers to continue following their patients for Women’s Health and allow them to file a Women’s Health Annual office visit code that would reimburse the Network Ob-Gyn Provider for the office visit that includes only Women’s Health Services. Network Ob-Gyn Providers also have the option to file compliant Healthy You! visit and covered services using the Healthy You! Coding Guidelines. These services include:
Women’s Health Office Visit
Pap Smear
Pelvic Exam
Breast Exam
Mammogram
Network Ob-Gyn providers will be able to file claims with an Office Visit or Pap Smear or both and have the claim processed with cost sharing for the office visit and no cost sharing for the pap smear and/or mammogram if filed in accordance with a new coding guidelines for Women’s Health. These guidelines can be seen below.
Providers will designate the Women’s Health visit as Women’s Health by utilizing defined CPT codes pointed towards a wellness diagnosis code.
If a Pap smear is filed, it will continue to be paid under the Healthy You! benefits.
The Women’s Health visit can be filed once per calendar year and be covered with cost sharing under a member’s contract benefits.
Biometrics will not be required to process this visit.
Network Ob-Gyn Providers will still be able to file wellness visits as Healthy You! if they truly perform all the services associated with a compliant Wellness visit.
Network Ob-Gyn Providers will not, however, be able to file a Women’s Health visit claim and perform Healthy You! labs at the same time. They will either have to file a Healthy You! visit and be subject to the Healthy You! coding guidelines or file a Women’s Health visit.
Network Ob-Gyn Providers would still be able to file claims as usual for any illnessrelated care.
The above policy does not apply to the State Health Plan (SHP) participants.
The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefitsplan language.
8/22/2018: Policy drafted.
10/6/2020: Policy reviewed and no changes made.
9/22/2021: Policy updated.
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