US · guidance
CMS Pub. 100-04, ch. 9, § 70
General Billing Requirements for Preventive Services
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.
History
(Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5aa0c54fed7e82290082b6b8b40587ff28b677f42cbae069ce86baeeef4d059f
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