As long as the state covers all United States Preventive Services Task Force (USPSTF) grade A and B services, Advisory Committee on Immunization Practices (ACIP) recommended vaccines, and their administration, without cost-sharing, such services will be eligible for the one percentage point federal medical assistance percentage (FMAP) increase. State Medicaid agencies should work with, and communicate to, providers concerning state-specific systems and the appropriate codes to use.
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Date
Topic
Sub Topic
FAQ ID
92041
FAQ Page
FAQ Question
Under section 4106 of the Affordable Care Act, what diagnosis codes must be billed in order to claim the 1% federal medical assistance percentage (FMAP) increase (the United States Preventive Services Task Force (USPSTF) A and B does provide a list of codes - should we limit our review to them)? Are we required to make sure these services are for preventive screening and not for disease diagnosis? For example, anemia testing in pregnant women can be part of routine prenatal care, and a provider may order it later in a pregnancy if the woman complains of fatigue. The same service may be screening or diagnostic. How does CMS want states to differentiate? For example, we will pay a lab claim for a lipid panel. Having to match with the International Classification of Diseases (ICD) code (e.g. the presence or absence of hyperlipidemia) is burdensome, and ICD code may reflect either existing condition or purpose of ruling out that condition. The Medicaid billing codes associated with the eligible preventive services verify that a service was provided; they do not differentiate between services that are provided for preventive reasons and services that are provided for diagnosis maintenance. We would like CMS guidance on how this differentiation is to be identified.