Name of Manual - Blue Cross and Blue Shield of Minnesota

Blue Plus
OB/GYN Open Access
Diagnosis (continued)
Code Description
V71.5 Observation following alleged rape or seduction
V72.31-
V72.42
Gynecological examination
Pregnancy examination or test, pregnancy
unconfirmed
V74.5 Special screening examination for venereal
disease
V76.10-
V76.19
Special screening for malignant neoplasms of
breast
V76.2 Special screening for malignant neoplasms of
cervix
*Includes all codes (4th or 5th digit) under this category.
Vision Care Fully insured members have direct access to general eye care
services rendered by Aware participating optometrists and
ophthalmologists. Appropriate ophthalmologist services including
eye examinations and Evaluation and Management (E/M)
procedure codes as well as CPT codes 65205, 65210, 65220,
65222, and 68761 are eligible. Some self-insured groups also
include this benefit. Major surgical procedures and follow-up care
will continue to be coordinated through the member’s PCC.
6-26 Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10)