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Published byStephany Johnson Modified over 9 years ago
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The Wellness Division of
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This program is designed to help our members identify their health risks and take steps to improve their health.
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Eligible HealthChoice members must: Complete their free comprehensive preventive services visit Complete their free comprehensive metabolic and lipid panels Complete their health risk assessment
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Eligible Providers must: Participate in the HealthChoice Provider Network Provide services in an outpatient or medical setting Bill the designated CPT Codes for 100% reimbursement of Allowed Charges
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New Patient – Initial Comprehensive Preventive Medicine Exam 99385 – patient age 18-39 99386 – patient age 40-64 99387 – patient age 65+ (non-Medicare)
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Established Patient – Comprehensive Preventive Medicine Exam 99395 – patient age 18-39 99396 – patient age 40-64 99397 – patient age 65+ (non-Medicare)
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Metabolic Panel 80053 – comprehensive metabolic panel or 80050 – general health panel Lipid Panel 80061 – comprehensive lipid panel
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When you use the CPT Codes designated for the H.E.L.P. program, services are covered once per calendar year at 100% of the HealthChoice Allowed Charges, regardless of the patient’s diagnosis. There is no copay or other out-of-pocket cost to the HealthChoice member.
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Multiple procedures/codes can be billed at the same time as the free preventive exam; however, additional services outside the H.E.L.P. program are subject to all Plan provisions including deductibles, copays, and coinsurance.
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Biometric Results Height and weight Blood pressure (systolic/diastolic) Resting heart rate (pulse) Lab Results Fasting blood glucose Fasting LDL, HDL, and total cholesterol Fasting triglycerides
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Certain preventive services are now covered at 100% of the HealthChoice Allowed Charges. Members must meet specific criteria including age, sex, policy limits, and diagnosis and procedure codes. Eligible members have no copay or other out-of- pocket costs. A list of these preventive services, including criteria, can be found on the HealthChoice Provider Website under Quick Links.
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If you have questions or need additional information, please contact HP Administrative Services, LLC at 1- 405-416-1800 or toll free 1-800-782- 5218.
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