G-Codes: G0402, G0438, G0439
The annual wellness “FREE” visit provided by Medicare and private insurance companies is very limited. It does not include most diagnostic testing and does not include treatment of chronic conditions or treatment of any acute illnesses. Our providers follow evidence based medical guidelines from national medical organizations to individualize treatment plans and goals for you. As such, these services are likely covered by your health insurance policy; however, applicable co-pays, coinsurance and deductible may apply.
You will be asked to complete an ADVANCED BENEFICIARY NOTICE (ABN) prior to services being rendered. Please make sure you read this document and select an option to receive or to not receive the services suggested by your medical provider. We highly recommend you contact your health insurance carrier to become familiar with your benefits. Any additional tests required during any wellness exam may not be covered under wellness, and may incur additional out of pocket expenses as explained above. Please make sure to contact your insurance carrier to obtain a listing of coverage details relating to your plan for all wellness and problem focused related visits.
As you may be aware, Medicare now provides coverage for an “Annual Wellness Visit” in addition to the one-time “Welcome to Medicare Physical Exam”.
As primary care physicians and practitioners, we know the cornerstone to your health is prevention. This new benefit is designed to focus you and your provider on plans for prevention and wellness. We believe this service will be valuable to you and we encourage you to learn about it. There are specific Medicare guidelines for the new Annual Wellness Visit, and it is not what most people commonly think of as a yearly “physical exam”. It is not a “HANDS ON” exam. Rather, it is a Review of Your Health, plus Education and Counseling about preventive services. This visit is designed to focus on health promotion and prevention planning. Because of this, it is difficult to address new or chronic conditions during this visit so your provider may ask you to schedule a separate visit to appropriately address those issues.
At the Annual Wellness Visit, your provider will work with you to create a personalized plan to help keep you at your best health over the next few years. To do this, your medical history will be updated, including a list of all your other health care providers. Your blood pressure, height and weight measurements will be taken, and there will be a screening for conditions related to cognitive impairments, depression, and functional status. To prepare for this, you should bring the following with you:
- A list of your medicines and allergies
- A list of your medical conditions and surgeries
- A list of any of your other health care providers
This information will help us guide your healthcare and provide you advice designed to improve your overall health.
As always, we appreciate the trust you put in us to take care of all of your healthcare needs and hope that you will take advantage of this new benefit. If you would like to schedule an appointment, for any reason, please call the office location where you visit your provider.
Limited review of your medical and family history.
Does not include evaluation and treatment of any illness or symptoms.
Obtaining vital signs:
- Temperature
- Height
- Weight
- BMI
- Blood pressure
- Respiration rate
- Oxygen level
Review of your current medications
- It does not include medication refills, or any new medication prescriptions.
An Advanced Beneficiary Notice (ABN) will be provided. This is designed to help you understand your visit and what tests your provider has ordered.
List of Preventive Care Services Offered at Apex MD
- Blood Pressure Screening
- Diabetes Screening
- Lipid Disorder Screening
- Cervical Cancer Screening: Pap test and pelvic exam
- Breast Cancer Screening: Clinical breast exam and self-exam instruction
- Skin and other Cancer Screening
- Routine Depression Screening
- Testicular and Prostate Cancer Screening
- Assessment: Body Mass Index (BMI), diet, exercise, vision, hearing
- Immunization History Review and Catch-Up administration
- Counseling: Tobacco cessation, alcohol/drug use, STD prevention, contraception, diet, exercise
- Sexually Transmitted Disease (STD) prevention
Preventive Wellness/Comprehensive Physical Examination
The exam is comprised of these tasks:
- Head to Toe Physical Examination
- Breast and or Pap Exam
- Prostate Exam
- Pelvic Exam
- Body Mass Index (BMI)- Height and Weight
- Temperature
- Oxygen Level
- Blood Pressure
- Electrocardiogram (EKG)
- Chest X-ray (IF NEEDED)
- Urine Analysis
- Blood Work (Basic)
- Kidney/liver Function
- CBC (Complete Blood Count)
- Cholesterol (Lipids)
- HbA1C (Status of Prediabetes or diabetes
- Blood Work (If Needed)
- Vitamin D
- Thyroid
- Female or Male Hormone Panels
CPT and Diagnosis Codes:
Physical Examination
- CPT Code depends on age and whether you are a new or an established patient with our practice (Ex: 99385 means “well visit new, age 34”)
EKG: CPT Code 93000
Urine Analysis: CPT Code 8100
The below four codes may and not be covered may insurance. But it’s important to do them. Some insurance company cover for all these labs and some does not.
- CBC (Blood Count) 85027
- CMP ( Kidney and liver test)80053
- Lipids ( cholesterol) 80061
- HbA1C ( Status of diabetes or prediabetes) 83036
Other labs CPT CODE AS NEEDED
- Thyroid 84443
- Vitamin D 82306
- Vitamin B12 82607
- Estrogen 82670
- Testosterone 84403
- DHEA 82626
- Progesterone 84144
- Cortisol 82533
- T4 84436
- T3 84480
- TPO 86376
- Reverse T3 84482
- TSH 84443
- Thyroid Panel 000455
- FSH 83001
- ANA 86038
- RA Factor 86431
- CRP 86140
- Lyme’s Test 86618
- Free T3 010289
- T3 Uptake 001156
- TBG 001735
- NMR 80061, 83704