2025 IHA coding updates + CBI workshop recording available
Initial Health Appointment (IHA) coding updates
A new coding update to Initial Health Appointment (IHA) will be applied to new patient office visits beginning Jan. 1, 2025. This coding update will impact the Provider Portal Reports and the Care-Based Incentive (CBI) program.
The 99204 and 99205 will now require the same ICD-10 restrictions as the 99215. To be captured, claims will need to include a diagnosis from the following options:
- Z00.00.
- Z00.01.
- Z00.110.
- Z00.111.
- Z00.121.
- Z00.129.
- Z01.411.
- Z01.419.
- Z00.8.
- Z02.1.
- Z02.89.
- Z02.9.
IHA billing codes
| Member population | CPT billing codes | ICD-10 reporting codes |
| Preventive visit, new patient. | 99381-99387 | No restriction. |
| Preventive visit, established patient. | 99391-99397 | No restriction. |
| Office visit, new patient. | 99204-99205 | CPT and appropriate diagnosis code: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z01.411, Z01.419, Z00.8, Z02.1, Z02.89, Z02.9 |
| Office visit, established patient. | 99215 | CPT and appropriate diagnosis code: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z01.411, Z01.419, Z00.8, Z02.1, Z02.89, Z02.9 |
| Prenatal care. | Z1032, Z1034, Z1038, Z6500 | Pregnancy related diagnosis. |
For more information, please see the Care-Based Incentive webpage for more information.
2025 CBI workshop recording now available
If you missed our 2025 Care-Based Incentive (CBI) workshop in October, you can now watch a recording on our website. The webpage also has the 2025 CBI workbook, workshop slides and FAQs. Office staff and providers are encouraged to watch this recording.
- Some of the information the workshop covers includes:
- Payment structure.
- 2025 measure changes, retired measures and new measures.
- Provider Portal Report updates.
- Resources such as the Data Submission Tool (DST) and grant opportunities.
If you have any questions, please reach out to your Provider Relations Representative.
