UHC Provides Resource for Coding Well Visits

February 25th, 2011

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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5 Responses to UHC Provides Resource for Coding Well Visits

  1. Katharine Mikula Says:

    Hang on to your hats, Billers. Here we go……..Why is UHC including 99385-99387 and 99395-99397 for billing “”"”Medicare Services”"”". I was under the impression that thses codes were ‘non-payable by Medicare. Does anyone see these codes listed on the Medicare fee schedule? And what about deductibles not mentioned in this article?

    OK, I understand that a Medicare patient gets an IPPE service within 12 months of getting Medicare coverage. Then 12 months later they can have an AWV and another one following 1 year thereafter. … I am getting paid from Medicare for initial AWV with Dx code V700. I’m pleased about that. So far, ****Medicare*** isn’t passing on co-payments and deductibles to the patient. So, what’s happening with other insurances? and Medicare Advantage programs?
    Anyone out there?…….

  2. Danielle Graf CPC CIMC Says:

    Most of the Medicare advantage plans have been paying the 99385-99387 and 99395-99397 for years, they were required to at least meet what is offered by Medicare but were allowed to offer additional benefits. We have not had any problems with Advantage plans paying either.

  3. Mary Jane Zismer, CPC Says:

    Medicare says that —> Abdominal aortic aneurysm (AAA) screening when a referral for the screening is received as a result of the—-> IPPE, only. I have searched CMS, called our local Medicare carrier and have been unable to locate any information that says they will cover the AAA screening at any other time. If someone else has confirmation of this being covered outside of the IPPE please let me know.

  4. Diana Sheets Says:

    They will pay for AAA screening if the patient has never received one, especially those patients who were already outside the guidelines for billing an IPPE. This is taken from the CMS Preventive Services Manual.

    Coverage Information
    Medicare provides coverage of a one-time preventive ultrasound screening for the early detection of an AAA for eligible beneficiaries who meet the following criteria:
    ` `
    ` `
    ` `
    ` `
    The beneficiary receives a referral for an ultrasound screening as a result of an IPPE;
    The beneficiary receives a referral from a provider or supplier who is authorized to provide covered ultrasound diagnostic services;
    The beneficiary has not been previously furnished an ultrasound screening under the Medicare Program; and
    The beneficiary is included in at least one of the following risk categories:
    ` `
    ` `
    ` `
    The beneficiary has a family history of AAAs;
    The beneficiary is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime; or
    The beneficiary manifests other risk factors in a beneficiary category recommended for ultrasound screening by the United States Preventive Services Task Force (USPSTF) regarding AAAs, as specified by the Secretary of Health and Human Services through the national coverage determination process.
    Medicare provides coverage for the ultrasound screening for AAA as a Medicare Part B benefit. The coinsurance or copayment applies. There is no Medicare Part B deductible for this benefit.

  5. Cindy Says:

    Do you append modifier 25 on the annual wellness visit when they get a pneumococcal vaccine at the same time?

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