When a Ladies First member has an abnormal Pap test or mammogram result it can be a difficult time for her. There are so many questions, doctors, things to learn, choices and concerns.
The Ladies First clinical navigator helps patients through work-up, initiation of treatment and validation of diagnosis so the member can get health care coverage for treatment. The clinical navigator works with providers to make sure members are aware of services, guides them through the health care system and links them to critical community services.
Referring members to the Ladies First clinical navigator provides education and faster access to health care services and information, fewer late or missed visits, and empowers members to have more control and confidence in their health care choices. View more about Ladies First
breast and cervical health navigation and
hearth health navigation.
Changes to 2016 Fee Schedule
Clinical Procedure Codes (CPTs) no longer covered
2016 Fee Schedule has been posted and is effective for
services provided in 2016. It is a guide to the services covered by the Ladies First program. The reimbursement rates are based on the Medicare Part B fee schedule.
Effective date of service 07/01/2016, codes G0463 (Provider Based Billing), Effective date of service 8/1/2016 99499 (Provider Reporting), and all Quality Category II Codes (starting with 0513F and ending the list with 7025F) will no longer be covered by the Ladies First Program.
Consultations and Second Opinions
Covered by Ladies First
Referrals for consultation for follow-up of abnormal screening and diagnostic results should be made to physicians with expertise in managing cervical and breast problems, including performing diagnostic procedures. Specialists, general surgeons, radiologists, and obstetricians-gynecologists who have completed specialized training for management of cervical and breast issues can also be considered. Consultations and second opinions can be billed using office visit codes and are covered by Ladies First.
FAQs about Clinical Trials
Importance of including the underserved
Underserved patients may be people in a racial or ethnic minority group or people who have low income or low education. Older adults, people who live in rural areas or patients who have a co-morbidity, can also be underserved. They must be included in trials to know whether treatment options work for that population, and historically these populations have often been left out of therapeutic trials.