Reminder: Every Woman Counts Program Approved CPT Codes and Appropriate ICD-10-CM Codes Updated

April 4, 2022

Providers are reminded that effective for dates of service on or after March 1, 2022, the list of approved CPT® codes and appropriate ICD-10-CM codes for the Every Woman Counts (EWC) program are updated.

Primarily, CPT codes 99241, 99242 and 99243 are no longer EWC benefits for referral providers. Previously, these CPT codes may have been used by referral providers to bill for EWC office consultations. Instead, EWC referral providers should bill using the following CPT codes for office or other outpatient visits for patient evaluation and management:

  • 99202, 99203, 99204, 99212, 99213 and 99214

These CPT Codes are already in use by other EWC primary care providers authorized to provide breast and cervical cancer services.

Providers should note that regardless if they are a referral provider or a primary care provider for the EWC program, EWC CPT and HCPCS codes are eligible for reimbursement only if they are submitted with the appropriate ICD-10-CM codes shown in tables 1a, 1b, 1c, 2a and 2b in the Every Woman Counts section of the provider manual.

Providers may select up to two EWC approved ICD-10-CM codes as shown in tables 1a, 1b, 1c, 2a and 2b. Claims submitted with diagnosis codes not represented on tables 1a, 1b, 1c, 2a and 2b will be denied.

For information on submitting a correction to a denied claim, refer to the CIF Overview section of the Part 1 provider manual as well as the CIF Submission and Timeliness Instructions and CIF Special Billing Instructions sections of the Part 2 provider manual.