00.06.02av, Preventive Care Services

By June 30, 2025: Billing team must update billing software and claim submission systems to reflect code changes. ACTION 1 - For colorectal cancer screening: Add HCPCS codes J0165, J2312, J2313, J3373 as covered preventive codes and remove/terminate codes J0171, J2310, J2311, J3370 from all claim edits and fee schedules. ACTION 2 - For routine immunizations: Add CPT codes 90611, 90683, 90684, 96380, 96381 to the preventive vaccines section and remove CPT codes 90380, 90381 from all billing templates. ACTION 3 - Providers and front desk staff must verify member benefits prior to service date, as preventive coverage is subject to specific benefit contract terms. ACTION 4 - Update encounter forms and clinical documentation templates to reflect new exercise intervention criteria for fall prevention (must include at least one component: gait training, balance training, functional training, strength/resistance training, flexibility, or endurance training for adults 65+). ACTION 5 - Update pediatric preventive visit workflows to document when obesity counseling reaches 15+ minutes threshold, triggering separate CPT code reporting rather than bundling with preventive exam. Failure to update billing rules will result in claim denials for new codes and potential overpayment recovery for obsolete codes.