Preventive Services
USPSTF Grade A and B recommendations and ACIP-recommended vaccines that ACA-covered plans must cover without cost-sharing.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS Preventive Services lists the covered services. Includes immunizations, cancer screenings, and many others. Medicare has a parallel preventive-services list.
How it shows up in your practice
Train staff to identify and code preventive visits correctly so patients are not unexpectedly billed for cost-sharing.
Sources
- CMS — Physician Fee Schedulehttps://www.cms.gov/medicare/payment/fee-schedules/physician
Look up preventive service rules in Ask D3
Open ask d3 →Related terms
- BillingAnnual Wellness Visit (AWV)A Medicare-covered preventive visit (G0438 initial, G0439 subsequent) focused on personalized prevention plans.
- BillingInitial Preventive Physical (IPPE / Welcome to Medicare)One-time Medicare preventive visit (G0402) furnished within 12 months of Part B enrollment.
- BillingColonoscopy Modifier 33 (Preventive)CPT modifier indicating a preventive service furnished under an ACA-required coverage benefit, waiving patient cost-sharing.
- BillingModifier PT (Screening Becomes Diagnostic)HCPCS modifier indicating a colorectal cancer screening test was converted to a diagnostic test or therapeutic procedure.
- BillingImmunization Codes (CPT 90460-90474)CPT administration codes for vaccines, paired with HCPCS / CPT vaccine product codes (90471 administration + 90686 flu vaccine, etc.).
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryImmunization Codes (CPT 90460-90474)CPT administration codes for vaccines, paired with HCPCS / CPT vaccine product codes (90471 administration + 90686 flu vaccine, etc.).
- GlossaryColonoscopy Modifier 33 (Preventive)CPT modifier indicating a preventive service furnished under an ACA-required coverage benefit, waiving patient cost-sharing.
- GlossaryAnnual Wellness Visit (AWV)A Medicare-covered preventive visit (G0438 initial, G0439 subsequent) focused on personalized prevention plans.
- GlossaryInitial Preventive Physical (IPPE / Welcome to Medicare)One-time Medicare preventive visit (G0402) furnished within 12 months of Part B enrollment.
- GlossaryModifier PT (Screening Becomes Diagnostic)HCPCS modifier indicating a colorectal cancer screening test was converted to a diagnostic test or therapeutic procedure.
- GlossaryCardiac Stress Test (93015-93018)CPT codes for cardiac stress testing, with separate codes for the global service, supervision, and interpretation.
- GlossaryCharge CaptureThe process of identifying and recording every billable service furnished during a patient encounter.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.