CPT Code Pocket Guide for Preventive Services

With the passage of the Affordable Care Act (ACA), access to preventive services has increased for the general patient population. ACA requires group health plans and health insurance issuers to cover preventive services without imposing associated cost-sharing obligations on enrollees. These provisions expand coverage of preventive services by promoting access to health care services in rural areas and improving payments for primary care services in general.

Much of our nation's increased health care spending is due, in large part, to the increased prevalence of chronic conditions (high blood pressure, diabetes, etc.) and unhealthy lifestyle behaviors, such as poor nutrition, physical inactivity, smoking and alcohol misuse. By expanding preventive care, we can decrease health care costs, increase efficiency in health care spending, reduce the burden of preventable disease and achieve the ultimate goal: helping more patients live healthier lives.

The American Medical Association (AMA) is pleased to offer the preventive service CPT® code pocket guide.  It highlights optimal vaccine and preventive services in specific age categories for which coinsurance/deductibles are waived according to Centers for Medicare and Medicaid Services (CMS). This guide was designed to help you easily reference information regarding U.S. Preventive Service Task Force graded recommendations for categories of preventive services and vaccines by age group with corresponding CPT and Medicare (HCPCS) codes.

CPT code pocket guide: Preventive services with cost-sharing waived

Medicare preventive services: A new benefit for patients and physicians