# Billing sports physicals



## beeacho (May 8, 2013)

1.  What is best way to bill a sports physical and filling out the form to 
            Indiana Medicaid?

2.  If the sports physical is done with the yearly exam - what is appropriate 
          way to bill Mediciad?


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## airart (May 31, 2013)

Here is a link and info regarding benefits for Wellness exam for Hoosier Healthwise Medicaid Package C. (CHIP) - Hope it helps.  

Covered Services Not in Need of the Doctor's Referral.
•	Dental care 
•	Podiatrist care (foot care) 
•	Chiropractic care 
•	Eye care (except surgery) 
•	Mental health services 
•	Substance abuse services 
•	Transportation service 

If you need any other special service or would like to see another type of medical professional, you do need to talk with your doctor to get a referral.  Some services will require your doctor (or other special provider) to request a Prior Authorization(PA) before the service can be delivered.  It is up to the provider to request the PA.


*Checks for Your Children*
All children and adolescents in Hoosier Healthwise should have regular Early and Periodic Screening, Diagnosis and Treatment (EPSDT) checkups. It is important that you contact your child's doctor to schedule these visits.   For more information about EPSDT checkups, you can call the Hoosier Healthwise Helpline at 1-800-889-9949 or contact your managed care organization (Anthem, MDwise or MHS).
The following should be included in every visit:
•	Comprehensive health and developmental history; 
•	Comprehensive unclothed physical exam; 
•	Nutritional assessment; 
•	Developmental assessment; 
•	Vision screening, Hearing screening, and Dental observation; 
•	Laboratory tests and Immunizations; 
•	Health education 

4 Years - Schedule an EPSDT/well child exam. He/she will also be eligible for vaccines required to enter kindergarten.

5 Years (Kindergarten) - Schedule an EPSDT/well child exam; receive all lab work and vaccines that are required to enter kindergarten.

6 - 18 Years - Schedule an EPSDT/well child exam annually.

PROFESSIONAL BILLING REQUIREMENTS 

Preventive Medicine Services: New Patient 
Preventive medicine services for a new patient start with an initial comprehensive preventive medicine evaluation. That includes an age and gender-appropriate history, examination, counseling, risk factor interventions, and the ordering of appropriate immunizations, laboratory and diagnostic procedures. Bill for these services using the following codes: 

Code 	Description 
99381 	Infant (Under 1 Year) 
99382 	Early Childhood (Ages 1-4) 
99383 	Late Childhood (Ages 5-11) 
99384 	Adolescent (Ages 12-17) 
99385 	Ages 18-39

PROFESSIONAL BILLING REQUIREMENTS 
Preventive Medicine Services: Established Patient 
Preventive medicine services for an established patient involve re-evaluation and management of existing conditions, if any. That includes an age and gender-appropriate history, examination, counseling, risk factor interventions, and the ordering of appropriate immunizations, laboratory and diagnostic procedures. 

Code 	Description 
99391 	Infant (Under 1 Year) 
99392 	Early Childhood (Ages 1-4) 
99393 	Late Childhood (Ages 5-11) 
99394 	Adolescent (Ages 12-17) 
99395 	Ages 18-39 
99396 	Ages 40-64 
99397 	Ages 65 and older 

http://member.indianamedicaid.com/p...-wellness-programs/hhw-wellness-programs.aspx

Article on Sports Physicals and Billing:
Sports Physicals: A Coding Conundrum
Link: 
http://www.aafp.org/fpm/2006/1000/p39.html


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