General Billing Requirements for Preventive Services

70 - General Billing Requirements for Preventive Services (Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25) Professional components of preventive services are covered under the RHC and FQHC benefit. The payment for most preventive services is included with a qualified visit as part of the overall encounter/visit. To ensure coinsurance and deductible (deductible applies to RHC claims only) are applied correctly, detailed HCPCS coding is required for approved preventive services recommended by the USPSTF with a grade of A or B for TOBs 71X or 77X. Additionally, there are some preventive services which are subject to frequency limitations.