Preventive care is a significant part of a family doctor’s work. The Prevention fee, also known as the Personal Health Risk Assessment fee, is the fee code billed for the service of preventive care that a family physician provides to a patient. In this blog, we explain how to correctly bill for this fee code to ensure you get paid for the care you provide.
Here are the details for the Prevention fee code and the value the doctor receives for providing this service.
|PG14066||Prevention / Personal Health Risk Assessment||$50.31|
Patient Eligibility Requirements
The Prevention fee is only eligible to patients who are living at home or assisted living. Patients in acute and long-term care facilities are not eligible.
Doctor Eligibility Requirements
The Prevention fee code 14066 is payable to the family physician who is most responsible for the majority of the patient’s longitudinal primary medical care. The physician must be the one who undertakes a Personal Health Risk Assessment with a patient in one of the five following target populations:
- Unhealthy eating
- Physical inactivity
- Medical obesity
- At risk for substance use
The fee is only eligible for those MRP FP who have submitted the PG14070 Portal (or PG14072 for locum) on a prior date in the same year. Physicians working under an Alternative Payment/Funding model whose duties would otherwise include provision of this service cannot bill for this service.
Payment Rules for Prevention Fee Code 14066
The Prevention fee code 14066 is payable once per calendar year per patient with a maximum of 100 patients per calendar year, per physician. Here are the payment requirements required for this fee:
- The discussion with the patient and the resulting preventive plan of action must be documented in the patient’s chart.
- Payable in addition to a visit fee (home or office) on the same day if medically required and does not take place during a time interval that overlaps with the face-to-face planning included under PG14066.
- PG14077 or PH14067 payable on same day for same patient if all criteria met.
- PG14033, PG14043, PG14063, PG14076 and PG14078 not payable on the same day for the same patient.
- Not payable once PG14063 has been billed and paid as patient has been changed from active management of chronic disease to palliative management.
Diagnostic Codes to Bill with the Prevention Fee Code 14066
When submitting the Prevention fee, physicians must use one of the following ICD-9 diagnostic codes to indicate the target population to which your patient belongs.
|Target Population||Diagnostic Codes|
|Tobacco / Smoking||ICD-9 786|
|Unhealthy eating||ICD-9 783|
|Physical inactivity||ICD-9 785|
|Medical obesity||ICD-9 783|
|At risk for substance use||ICD-9 V82|
Lifetime Prevention Schedule
Family doctors using the Prevention fee are required to create a personalized plan to address the designated risk and recommend targeted clinical prevention actions. These must be consistent with the Lifetime Prevention Schedule (LPS) provided by the BC government. The LPS provides a schedule of the clinical prevention services available for British Columbians based on age and sex. These include screening, behavioral interventions and preventive medications provided by a health-care provider. The LPS reports show priorities for these services in B.C. based on each service’s clinical effectiveness, population health impact and cost effectiveness.
Have questions about the Prevention fee code 14066? Contact us today!