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 , CIGNA , UnitedHealthcare , and AAP ( Bright Futures and Printable 2012 Version ).

Children
Immunizations
Contraceptive Methods
Diabetes
Hypertension
Pregnancy

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
 

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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

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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

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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

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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

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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

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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

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