Medicare, Medicaid, Life and Health Insurance/Medical Bill Code


Hi Joy,

Last year I lost my job and bought an individual health insurance with Cigna. ($5000 deductible plan). I need to have annual ultra sound as follow up to monitor my cysts and my ob/gyn also recommend annual mammogram. I was told and confirmed by Cigna that Ultrasound and mammogram are under preventative women wellness and covered 100% (not counted as deductible).
However, after my service for ultrasound and mammogram, I was charged for $2,000 deductible. Cigna said because the billing code my gyn used was for Illness, and as long as the gyn change the code to wellness, Cigna will waive the $2000.
But my gyn office said they will not and cannot change the billing code.
My question is, what is the correct billing code for my situation? (My ultrasound was done for annual follow up to monitor the size of the cysts in my ovary and ultra sound to check the pain I felt under my breast).

Hi Amy

Because your ultrasound is due to a history of cysts it is considered a follow up to an existing condition which is not eligible as a preventative test. The ultrasound for pain under your breasts is also not eligible because it is due to a symptom. The only test that would be considered as preventative is a screening mammogram and there are certain criteria that must be met in order to be eligible. Each insurance is different but mainly follow similar guidelines such as must be every 1 - 2 years depending on your age and should be coded as a screening instead of due to a symptom or diagnosis. Read your policy handbook for specifics. Unfortunately, you may be responsible for the large balance but your doctor should have informed you in advance.  

Medicare, Medicaid, Life and Health Insurance

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Joy B. Hicks, MBA, CPM


As a Medical Office Expert, I can answer any question related to the medical office from the prospective of hospital and physician office staff and patients.


I have been in the medical office field for 12 years and also have a blog that provides advice, information, and tips about the medical office.


Certified Practice Manager
AAS Business Administration
BA Health Care Administration
MBA w/ healthcare specialization

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