Question Age limits on preventative medicine codes

adudms

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Albuquerque, NM
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I get rejections from NM medicaid on cpt code 99402 stating "only recipients under the age of 21 are eligible for these services". I CANNOT find ANY information on any website (CMS included) that states there is an age restriction on this code. Does anyone know something I don't?
 

sls314

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Toledo, OH
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I get rejections from NM medicaid on cpt code 99402 stating "only recipients under the age of 21 are eligible for these services". I CANNOT find ANY information on any website (CMS included) that states there is an age restriction on this code. Does anyone know something I don't?

That sounds like a benefit issue to me.

The code itself is not limited by age in definition, but New Mexico Medicaid may not provide coverage for the service for patients over the age of 21. You're going to want to follow up with New Mexico Medicaid specifically, either on the website or on the phone.
 

sls314

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Toledo, OH
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For what it's worth, I just did some poking around on the New Mexico Medicaid website. I posted part of a screenshot below.

It looks like there's no coverage under Standard Medicaid for preventative services for ages 21 and up. I would definitely suggest following up with someone at Medicaid to confirm that this information is still current. Good luck!

NM Medicaid.JPG
 

adudms

Networker
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Location
Albuquerque, NM
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For what it's worth, I just did some poking around on the New Mexico Medicaid website. I posted part of a screenshot below.

It looks like there's no coverage under Standard Medicaid for preventative services for ages 21 and up. I would definitely suggest following up with someone at Medicaid to confirm that this information is still current. Good luck!

View attachment 5029
Thank you SO much! I appreciate the time you took to look into this for me. Stay safe and well.
 
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