CAvila221
New
I am fighting with my husbands employer over their use of the phrase "free annual physical with blood work". He has UHC.
He is given a form that he hands to the doctor. One of the things that need to be checked is glucose. Doctor billed it with code 82947 and we were charged.
Below is the response from UHC rep that his employer contacted. My question is, is there even a code that would be considered preventative by itself or would they all need either an overweight, obese, history of diabetes code with it? Because if the only way its considered preventative if is he is overweight, then I don't believe his employer can come out and unequivocally say the physical is free.
After reviewing the claim for date of service 01/04/24, the code billed, 82947 is only preventive per the below guidelines. The service billed was not billed with a diagnosis to cause the service to be allowed as preventive. The claim processed correctly as billed. The member owes $8.82 which was applied to his In-Network deductible.
Preventive rules:
For Gestational Diabetes Screening: Payable with diagnosis of pregnancy
For Other Diabetes Screening: For ages 35 - 70yrs (ends on 71st birthday) payable with diagnosis of overweight, obesity* AND Z00.00, Z00.01, or Z13.1
The preventive benefit does not apply if a diabetes diagnosis code is present in any position.
For Those with a History of Gestational Diabetes:
Payable with Z00.00, Z00.01, or Z13.1; AND Z86.32
He is given a form that he hands to the doctor. One of the things that need to be checked is glucose. Doctor billed it with code 82947 and we were charged.
Below is the response from UHC rep that his employer contacted. My question is, is there even a code that would be considered preventative by itself or would they all need either an overweight, obese, history of diabetes code with it? Because if the only way its considered preventative if is he is overweight, then I don't believe his employer can come out and unequivocally say the physical is free.
After reviewing the claim for date of service 01/04/24, the code billed, 82947 is only preventive per the below guidelines. The service billed was not billed with a diagnosis to cause the service to be allowed as preventive. The claim processed correctly as billed. The member owes $8.82 which was applied to his In-Network deductible.
Preventive rules:
For Gestational Diabetes Screening: Payable with diagnosis of pregnancy
For Other Diabetes Screening: For ages 35 - 70yrs (ends on 71st birthday) payable with diagnosis of overweight, obesity* AND Z00.00, Z00.01, or Z13.1
The preventive benefit does not apply if a diabetes diagnosis code is present in any position.
For Those with a History of Gestational Diabetes:
Payable with Z00.00, Z00.01, or Z13.1; AND Z86.32
