Covered Services & Billing Tips | Vermont Department of Health

Covered Services & Billing Tips | Vermont Department of Health
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Translations for you
Covered Services & Billing Tips
You First for Providers
Covered Services & Billing Tips
Refer to You First
You First Provider FAQs
You First Provider Resources
Our goal is to make billing and reimbursement as efficient as possible for both You First members and providers. Here are some things to remember:
You First members should present their member card when they check-in for their visit.
Office staff should check their membership via
Medicaid’s Eligibility Verification System (EVS)
. For screening and diagnostic aid category "LF".  You First coverage will not appear in MMIS for members on Medicaid or Medicare.
Bill You First for covered services. Members eligible for coverage of clinical services should not receive a bill for any covered
You First services
. Members with Medicare Part B are not eligible for You First coverage of clinical services.
All Medicaid providers can bill for You First services. Others can enroll on the
Vermont Medicaid Portal
New members can submit eligible bills up to 90 days prior to their enrollment start date. A member's card will show their enrollment date plus a 90 day retroactive coverage period.
if you or your billing staff have any questions or concerns.
Covered Services
The You First program covers services in these clinical categories:
Breast cancer screening and diagnostic tests
Cervical cancer screening and diagnostic tests
Cardiovascular disease screenings for members 35-64
2026 Fee Schedule
Breast Cancer Services | Members 40+
Clinical breast exam
Screening Mammogram
Diagnostic Mammogram
Ultrasound
Consultation
MRIs
Second opinion
Breast biopsy
Breast cancer screening can begin before age 40 if recommended by provider.
Cervical Cancer Services | Members 21+
Cervical cytology (Pap test)
HPV testing
HPV and cervical cytology cotesting
Colposcopy
Diagnostic tests
Heart Health Services | Members 35-64
A cardiovascular disease screening visit that includes:
Two blood pressure results
Height and weight screening
Fasting blood glucose or Hgb A1c testing (either in the office or at a lab)
Cholesterol test (either in the office or at a lab)
Additional Benefits
In addition to these services, all members get:
Personalized help understanding their screening needs, results and next steps
Help scheduling and arranging transportation to You First health care appointments.
Members aged 35-64 are eligible for an array of FREE lifestyle and wellness benefits, including:
Support from a local health coach via phone or email
At-home blood pressure monitor
Local gym memberships and at-home fitness equipment
Local farmers market coupons and CSAs
State Park Passes
Have a patient who may be eligible for You First? Encourage them to
and we'll help them apply.
Services Not Covered by You First
Genetic testing and counseling
Pelvic and transvaginal ultrasound
Endometrial biopsy (unless patient has Atypical Glandular Cells of Undetermined Significance [AGUS] Pap test results).
Cervical conization (can be covered by the Vermont Breast and Cervical Cancer Treatment Program, if eligible)
Gonorrhea, chlamydia, and other STI tests
Electrocardiogram
Thyroid stimulating hormones test (TSH)
Bone density test
More Billing Guidance
The status and payment information of all claims submitted for processing to Vermont Medicaid for You First members can be found in the remittance advice (RA) provided by Vermont Medicaid and accessed either electronically through the Vermont Medicaid Portal or received weekly by mail. If you have questions or need assistance in understanding the reason for a claim denial, please contact us.
The
You First fee schedule
is in accordance with the CDC guidelines and all fees are based on the average Medicare Part B rate. As a You First provider, you agree to write-off any remaining balances of You First covered procedures and not bill the members.
Bill primary insurance first. You First is the payor of last resort.
Submit billing through the Vermont Medicaid billing system with Gainwell Technologies. Or mail to Gainwell Technologies Box 888 Williston, VT 05495.
If you have any billing questions, please contact the You First program at
800-508-2222
or email
[email protected]
For general questions or inquiries, contact us Monday to Friday, 7:45AM to 4:30PM:
Call:
800-508-2222
TTY/TDD: Dial 711 first
Email:
[email protected]
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March 25, 2026