Regence MedAdvantage - Wellness Visit Program
Overview
Our Annual Wellness Visit Program is specific to Regence MedAdvantage members. The outreach program encourages these members to schedule an appointment with their physician or other health care professional for an annual wellness visit.
Providers who participate in the program are eligible to receive an extra $50 in reimbursement for each patient who has an eligible preventive examination when we receive complete supporting documentation for the visit.
Annual wellness visit
Medicare covers an annual wellness visit with no member copayment or deductible. Specific Healthcare Common Procedure Coding System (HCPCS) codes are available to support claims for these visits:
- G0438 – Annual wellness visit, includes a personalized prevention plan of service (PPS), initial visit
- G0439 – Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit
Required components of annual wellness visits
To be eligible for reimbursement, the following are required to be performed at the time of visit:
- Measure blood pressure
- Screen for cognitive impairment
- Create and maintain the following lists:
- Treatment options and their associated risks and benefits
- Current providers and suppliers who provide medical care to the patient
- Risk factors and conditions for which treatment is underway or recommended
- Review functional ability and level of safety
- Establish or review patient medical and family history
- Establish or review a written screening schedule for the individual
- Measure height, weight, body-mass index (BMI) or waist circumference
- Provide personalized counseling and referrals as needed for covered screening and preventive services
- Discuss advance directives. If the patient has signed an advance directive document, make sure there is a copy in his or her medical record, and that it is easy to identify
The medical record documentation for wellness visits must substantiate that the provider addressed all CMS-required components listed above. Medical history documentation should include details of the patient’s medications and treatment history. Providers should identify chronic diseases, injury risks, modifiable risk factors and urgent health needs of the patient as well.
CMS offers these additional materials:
Learn more about the Medicare annual wellness visits (PDF).
Other eligible services
Additional preventive visits that are also eligible for this program are:
- Welcome to Medicare exam: G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment.
- Comprehensive preventive medicine evaluation and management: Current Procedural Terminology (CPT®) codes 99381-99397
- These examinations include:
- Age and gender appropriate history and examination
- Counseling, guidance and/or risk factor reduction interventions
- Ordering of appropriate laboratory and/or diagnostic procedures
Program features for providers
Regence MedAdvantage contracted primary care specialty-type providers are invited to participate in this program. Providers who elect to participate will:
- Submit claims for completed annual wellness visits, following normal claim submission guidelines. There are no extra forms to complete. Note: Annual wellness visits should be reported with International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) V70.0 “Routine general medical examination at a health care facility” as the primary diagnosis. Additional diagnoses may be added as appropriate.
- Receive a monthly report of claims processed for annual wellness visits.
- Submit complete documentation for each claim on the report (e.g., signed chart notes for the annual wellness visit). See components listed above for documentation requirements.
- Receive $50 in addition to the normal reimbursement for each completed and documented visit. Payment will be sent quarterly in March, June, September and December, as documentation reviews are completed. Effective April 1, documentation must be received within 60 days of the initial request date to be eligible for Annual Wellness Visit Program payment (does not affect claims processing).
We have made it easy to participate in this program. Enroll today.
Learn more about Medicare Advantage Plans.
Program features for members
RegenceMedAdvantage members will receive a letter reminding them of the importance of annual wellness visits and encouraging them to schedule a visit with their primary care provider. We have also provided a sample letter (PDF) that you can use to send to your Medicare Advantage patients as well.
Note: To print a PDF document, you need Adobe® Reader®. Download it now for free.
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