D-SNP Medicare Billing - Yearly (Annual) Physical Exam

Date: 10/26/22

Changes were made to the Wellcare by Allwell 2022 benefits, effective 1/1/2022, that impacted certain codes that may have been previously billable for our Dual Eligible Special Needs Plans (D-SNPs). Yearly (Annual) Physical Exam: 99381-99397 are not covered by our Wellcare Dual Liberty (HMO D-SNP) plans for 2022 dates of services.

Codes that are covered:

G0402 - Initial Preventive Physical Examination (IPPE)

G0438 Annual Wellness Visit, Initial (AWV): Annual wellness visit, including a personalized prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV): Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit.

G0468 Federally Qualified Health Center (FQHC) will bill this code for the Wellness visit.

ADDITIONAL INFORMATION

If you have questions regarding the information contained in this update, please feel free to contact our Provider Customer Service center (800-977-7522 TTY:711). If you need your assigned Provider Engagement Specialist contact information, please email D-SNP Medicare Billing - Yearly (Annual) Physical Examus at: AzCHProviderEngagement@azcompletehealth.com.