Preventative vs. Diagnostic Services in the Affordable Care Act  

Category: Coding

By: Matt Dallmann

Under the Affordable Care Act, insurance plans now cover preventative care without patient cost sharing, i.e. co-pays, co-insurance, or deductibles. However, services that are not classified as preventative care are still subject to cost sharing. It is important for physicians and their staff to be able to differentiate between the two in order to avoid blindsiding patients and affecting their revenue. Since the average deductible on plans offered through the state and federal health insurance exchanges is between $1,000 and $6,000, financial responsibility for a non-preventative visit could easily fall on the patient.

To clarify, here are a few examples of preventative care and diagnostic care:

Preventative services:

• If an abnormal finding on a preventative mammography screening is later ...
  
  

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