Home > Clinical & Pharmacy
Web Content Viewer
Web Content Viewer
Schedule wellness visits with your Medicare Advantage patients
December 6, 2022

This article is for primary care physicians caring for our Medicare Advantage members

Building a relationship with your patient has a significant impact on the quality of care that you provide. It can help you get a better picture of the patient’s health, including family history or predisposition to conditions that can be managed early on.

Annual wellness visits allow you to do just that; spend time with your patient, learn about their health behaviors, and help them find ways to lower the risk of developing disease complications. During these visits, be mindful of any cultural beliefs or barriers relevant to your patient. Disregarding these specific needs can often amplify health inequities, so it’s important to be sensitive and aware of your patient’s background.

We need your help talking to patients about screening options and at-home chronic condition monitoring.

It may be difficult for some patients to come in for routine appointments due to busy schedules or transportation hurdles.

Talk to these patients about telehealth options, as well as ways they can have screenings (such as colorectal cancer) and blood pressure readings done at home.

Best practices for annual wellness visits

  • Visits can be conducted in-person or via telehealth, and don’t have to be rendered by a primary care physician
  • Suggest home-based screening tools for your patients, such as:
    • FIT Kits or Cologuard testing
    • Home digital blood pressure monitors
  • Write 90-day supply prescriptions and consider using mail order pharmacies
    • This ensures that patients have adequate supply of their medications, and may reduce out-of-pocket cost

Read more in our Coverage story: How a wellness program saved a life.

As a reminder, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits using ConnectCenter to avoid surprise billing.

You can also learn more about additional support programs that are available to your patient by visiting our Member Support & Assistance Programs page.

How to bill for annual wellness visits

Annual wellness visits are covered for all Medicare Advantage members. Use the codes below to bill for this service.

HCPCS code Description
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit
G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit
For telehealth services
Use modifier GT, 95, G0, or GQ with the applicable place of service code to differentiate a telehealth visit from an in-person encounter with the patient.

As always, we thank you for the care that you provide to your patients—our members.