EmblemHealth Preventive Care/Screening Services Coverage (Revised)

Date Issued: 1/23/2019

EmblemHealth covers the following services in accordance with CMS Guidelines and requirements under the Affordable Care Act: HCPCS codes G0442, G0443, G0444, G0445, G0446 and G0447. In order to be reimbursed as a separately identifiable preventive service, Modifier 25 or Modifier 59 must be appended to HCPCS codes G0442 - G0447 when reported with an unrelated Evaluation and Management (E/M) service, in accordance with National Correct Coding Initiatives (NCCI) policies.

  • Claims with Modifiers -25 or -59 for the above services are allowed retroactively to 07/15/2016.
  • Starting on 11/12/18, claims with Modifier 59 are being processed prospectively.
  • All affected claims will be reprocessed. You do not need to resubmit these claims.

For more information, view the EmblemHealth Preventive Care/Screening Services table.