Because WellCare members are encouraged to receive an annual wellness visit and a physical exam each calendar year, we’d like to share a brief overview of the codes and applicable time intervals for these services.
Wellness Visits
G0402 - The Initial Preventative Physical Examination with EKG (IPPE) is offered once in a lifetime and must occur within the first 12 months of Medicare eligibility. This is the “Welcome to Medicare” visit that consists primarily of discussion and personalized prevention planning.
G0438 - The Initial Annual Wellness Visit with Health Risk Assessment (Initial AWV w/ HRA) is offered once in a lifetime and must occur after the first 12 months of Medicare eligibility and if the member did not receive an IPPE (G0402). This is very similar to the “Welcome to Medicare” visit as it consists primarily of discussion and personalized prevention planning.
G0439 - The Subsequent Annual Wellness Visit with Health Risk Assessment (Subsequent AWV w/ HRA) is offered once per year and must occur after the first 12 months of eligibility and 11 months after receiving and IPPE (G0402) or Initial AWV (G0438).
Physical Exam
993XX – The preventative visit with physical exam is offered once per year as an added benefit through WellCare. (Preventative visit code selection is age driven).
We hope that this is helpful, and we appreciate the care our providers give to our members!
