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Schedule wellness visits with your Medicare Advantage patients
December 27, 2021

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

Building a relationship with your patient is important to 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.

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

Some patients may be hesitant to come in for routine appointments due to inclement weather and the ever-changing COVID landscape.

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

  • Work with the nurse practitioner or physician assistant in your office to schedule visits for these members. As a reminder, you don’t have to be a primary care physician to conduct an annual wellness visit.
  • Conduct the wellness visit over telehealth.
    • Discuss at home monitoring and screening options (FIT Kits, digital blood pressure monitors, etc.)

Read more in our Coverage story: Seniors' yearly wellness visit is safer, easier, and more important than ever

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

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.