Name of Manual - Blue Cross and Blue Shield of Minnesota

C&TC Component Commonly Billed Code(s) Notes
Health History Not billed separately, part
of the E&M
Developmental /
Behavioral
Physical – including
sexual development
and oral exam
Immunizations /
Vaccines
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)
Coding Policies and Guidelines (Public Programs)
96110 or 96111 This code may be billed if a measurable
tool is used to assess the developmental
and behavioral level of the child.
99381-99385 or 99391-
99395
90460, 90461, 90470,
90471, 90472, 90473,
90474
Appropriate
vaccine/toxoid code with
an –SL modifier (if the
immunization is available
through the Minnesota
Vaccines for Children
program).
Laboratory Tests Billed as appropriate
Bill developmental and mental health
screenings using:
96110 for an objective, standardized
developmental screening instrument
96110-UC for a standardized mental
health screening instrument
This code is billed according to whether
the child is a new or established patient
and the age of the child.
Administration is billed with the
appropriate administration code(s).
Immunizations are billed with the
appropriate vaccine code appended with
an –SL modifier to indicate the vaccine
was obtained free through the Minnesota
Vaccines for Children program.
All providers must use the available free
vaccines for MHCP covered children.
Blood Lead 83655 Blood lead screening is a required
component at 12 & 24 months of age, but
can occur at other times within these
ranges if necessary. Lead testing is a
federally required component of C&TC.
Vision 99173 This code may be billed for children three
years of age and older to indicate that an
objective screening was performed.
Hearing V5008 or 92551 This code may be billed for children three
years of age and older to indicate that an
objective screening was performed.
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