UHC Provides Resource for Coding Well Visits
A new provider resource article posted on UnitedHealthcareOnline explains how physicians submitting claims to SecureHorizons, UnitedHealthcare Medicare Complete or Evercare should code the initial preventive physical exam (IPPE) and annual wellness visits (AWVs) for their Medicare patients.
In accordance with Medicare Part B policy, these plans entitle members to receive an IPPE within the first 12 months of Medicare Part B coverage with no copayment and an AWV every 12 months with no copayment.
Codes accepted by these plans for these services are:
|Procedure Code||Diagnosis Code||Procedure Description|
|99385-99387||V70.0||Initial comprehensive preventive medicine evaluation and management of an individual|
|99395-99397||V70.0||Periodic comprehensive preventive medicine reevaluation and management of an individual|
|G0402||Any appropriate code accepted||IPPE|
|G0438||Any appropriate code accepted||Annual Wellness Visit, including personalized prevention plan services, first visit|
|G0439||Any appropriate code accepted||Annual Wellness Visit, including personalized prevention plan services, subsequent visit|
These plans also will cover (with no copay) the following once-in-a-lifetime benefits:
- Abdominal aortic aneurysm (AAA) screening when a referral for the screening is received as a result of the wellness exam.
- Electrocardiogram (EKG)
Other screenings these plans cover with no copay include:
|Bone mass measurement||Flu shots|
|Breast cancer screening (mammograms)*||Glaucoma tests (for those at high risk)|
|Cardiovascular screening*||Hepatitis B|
|Cervical and vaginal cancer screening (Pap and pelvic exam)*||HIV screening|
|Colorectal cancer screening*||Medical nutrition therapy services|
|Diabetes screening||Pneumococcal shot|
|Diabetes self-management training||Prostate cancer screening*|
|Smoking cessation (counseling to stop smoking)|
*Some exceptions may apply. See resource for details.
Other separately identifiable services, including lab tests or other diagnostic services, provided during the visit may be subject to a copay or coinsurance “even if the primary reason for the visit was a wellness exam.”
For example, when a provider performs a separately identifiable medically necessary evaluation and management (E/M) service in addition to the IPPE, CPT® codes 99201-99215 reported with modifier 25 may also be billed. When medically indicated, this additional E/M service would be subject to the applicable copayment for office visits.
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