Medicare HMO annual visit CPT code G0402, G0438 and G0439 coverage

Medicare Advantage Program  Coding for Welcome to Medicare and Annual Wellness Visits


IMPORTANT REMINDER: Florida Blue, as a Medicare Advantage plan with four contracts with the Centers for Medicare & Medicaid Services (CMS), reminds you that Medicare Advantage Members are eligible for one Welcome to Medicare visit as well as an Annual Wellness visit. When filing these Medicare Advantage visit claims, it is important for you to use the correct procedure codes r to avoid claim denials.

• G0402 - Initial Preventive Physical Examination (IPPE) or Welcome to Medicare Visit
• G0438 - Annual Wellness Visit (AWV); includes a personalized prevention plan (PPPS)
• G0439 - Subsequent Annual Wellness Visit (AWV); includes a personalized prevention plan (PPPS)

Also, please refer to the bulletin of February 2015, Update: Medicare Advantage Program Coding for Annual Wellness Visits .

NOTE: Our plans do not cover routine physical examinations typically billed using the Preventive Medicine Services procedure codes 99381 – 99397. Effective for services performed on and after January 1, 2016, all visits billed with these procedure codes for Medicare Advantage members will be denied.
Remember to check member eligibility and benefits electronically through Availity

Stay up-to date with the latest Medicare preventive services news for Medicare beneficiaries by logging in to the CMS website at http://www.cms.gov/ and selecting the Outreach and Education tab.