Initial Health Assessment (IHA)

An IHA is a comprehensive assessment completed during a patient’s first visit with his/her PCP. The goal of the IHA is to assess acute, chronic and preventative health needs.  The IHA is a California Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid requirement.

All new members must have an IHA completed by their PCP within 120 calendar days of Plan enrollment.

IHA Components

  1. A comprehensive history, physical and mental status, and where age appropriate, a developmental exam and immunizations;
  2. An approved Individual Health Education Behavioral Assessment (IHEBA).  The Alliance recommends using the Staying Healthy Assessment alamedaalliance.org/providers/medical-management/staying-healthy-assessment;
  3. Appropriate guidance, health care coordination and referrals.  Health Education information and a Resource Directory of community referrals can be found on the Alliance website at alamedaalliance.org/providers/health-education-and-wellness-resources.

IHA Exclusions

  1. Members who have been a patient of yours in the past year or more and for which documentation exists showing an IHA completed within the past 12 months.
  2. Members who refuse the IHA.  Refusal must be noted within the medical record.
  3. Members who missed an appointment, where the provider documented two additional attempts to reschedule.

IHA CPT Codes

CPT Code

Description

99203- 99205

99213- 99215

Office or other outpatient visit for the evaluation and management of new or established patient

99381, 99391

Comprehensive Preventive Visit (Under 1 year of age) – 1st Well Baby Visit

99382, 99392

Patient, Early Childhood (Age 1 - 4 years) – Well Baby Visit

99383, 99393

Patient, Late Childhood (Age 5 - 11 years) – Well Child Visit

99384, 99394

Patient, Adolescent (Age 12 - 17 years) – Well Adolescent Visit

99385, 99395

Patient, Adult (Age 18 - 39) – Well Adult Visit

99386, 99396

Patient, Adult (Age 40 - 64) – Well Adult Visit

99387, 99397

Patient, Adult (Age 65+) – Well Adult Visit

59400, 59510, 59610, 59618

Pregnant members