Medicaid coverage for Adult screening services

An adult health screening is performed by a physician to assess the health status of a Medicaid recipient age 21 and older. It is used to detect and prevent disease, disability and other health conditions or monitor their progressions. This is an all-inclusive service. No separate billing for required or recommended components is allowed.

Adult Health Screening Procedure Codes

Medicaid reimburses adult health screening services for recipients age 21 and older with the following procedure codes and no modifier:

99385 for new patient screenings age 21-39;

99386 for new patient screenings age 40-64;

99387 for new patient screenings age 65 years and older;

99395 for established patient screenings age 21-39;

99396 for established patient screenings age 40-64; or

99397 for established patient screenings age 65 years and older.

Adult Screening Schedule

Medicaid will reimburse for one adult health screening every 365 days. Adult health screenings are recommended for:

Age 21 through 39, one screening every five years.

Age 40 and over, one screening every two years.

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