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State Health Plan Level 2 Office Visit Updates

October 27, 2009

Effective January 1, 2009, the State Health Plan (SHP) began paying for a level 2 office visit when performed in conjunction with a routine Pap smear. This notice clarifies liability for the difference in the allowance and charge for the office visit performed in conjunction with the Pap test.

The SHP will pay the level 2 exam rate 99212 for the office visit regardless of the office visit code filed. The difference between the allowance and the charge for the office visit billed will be the patient's liability. We are currently making changes to our system to accommodate this change on our provider remittance advices and member explanations of benefits. When we implement this change, we will automatically adjust any affected claims.

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