July 20, 2017
Have your Premera Blue Cross Medicare Advantage patients come in for their enhanced annual wellness visits? Different from traditional physicals, these visits emphasize care for chronic conditions and help you connect with your patients.
Enhanced annual wellness visits focus on health promotion, disease prevention, and any concerns or questions about specific conditions or overall health. We're encouraging our members to take advantage of this calendar year benefit at no cost to the member. This visit is also reimbursed at a higher rate than a traditional physical.
An enhanced annual wellness visit covers the assessment of two or more chronic conditions in addition to performing the components of a traditional annual wellness visit. The visit typically lasts 45 to 60 minutes and includes:
- Assessment of all chronic conditions and ongoing treatment plans
- Assessment of all status conditions such as ostomy, amputation, organ transplant, respiratory dependence, renal dialysis, paraplegia, and hemiplegia
- Screenings for conditions such as high blood pressure, diabetes, depression, and heart disease
- Bladder control and treatment
- Medications
- Preventive treatments for colon and other cancers, glaucoma, and osteoporosis
- Lab work as necessary (additional testing could result in member charges)
To bill for this visit, submit one of the following Healthcare Common Procedure Coding System (HCPCS) codes:
- G0438: Annual wellness visit; includes a Personalized Prevention Plan of Service (PPPS), initial visit
- G0439: Annual wellness visit; includes a Personalized Prevention Plan of Service (PPPS), subsequent visit
In addition to HPCS codes G0438 or G0439, submit the following HCPCS code (for the enhanced annual wellness visit if applicable):
- S0250: Comprehensive geriatric assessment and treatment planning performed by an assessment team
Important: To receive payment, fax chart notes to 855-348-9135.