MI-SERA

Chair Talk

May 2023

By Bob Kopasz

A couple weeks ago I received an email from Kathie Vaught (Lansing Chapter) suggesting that I do an article about the difference between the Medicare “Wellness visit” and an annual physical examination in our Preventive Care list we have in our Medicare Advantage PPO. Lo and behold a few days later I received an email chain from Kathie, Arva and a SERA member about that subject. Below is Arva’s explanation:

Hi Kathie,

Thanks for including me in this conversation. Below is some information that may be helpful.

Medicare Annual Wellness Visit

The yearly “wellness” visit isn’t a physical exam.

Medicare Advantage Plan covers this one per calendar year.

G0438 (initial wellness visit) and G0439 (subsequent wellness visit) are the two procedure codes providers can select from.

During the annual wellness visit the provider will perform an assessment and:

Review your medical and family history

Review your current providers and prescriptions

Develop or update a personal prevention plan based on your current health and risk factors

Provide a screening schedule for appropriate preventive services

Look for signs of dementia using a cognitive assessment

Provide advanced care planning so you’re prepared if you can no longer care for yourself

There is no member cost share for the annual wellness visit. If you are receiving other services at the time of this visit (e.g., diagnostic services), you could potentially have member cost share.

Medicare Annual Wellness Visit

Your provider will perform an age and gender appropriate hands-on exam.

Medicare Advantage Plan covers this once per 12-months.

Procedure code range for an annual physical exam is 99381-99385 and 99391-99395.

There is no member cost share for the annual physical exam. If you are receiving other services at the time of this annual physical (e.g., diagnostic services), you could potentially have member cost share.

I hope this information is helpful. Please do not hesitate to contact me if you have any questions.

Warm regards,

Arva Overton
Client Engagement Manager
National and Key Accounts
Blue Cross Blue Shield of Michigan

Editor’s note: Bob Kopasz is Chair of the Michigan SERA Council. He may be reached at P.O. Box 692, Mt. Morris, MI 48458; phone 810/240-8380.


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May 2023 By Bob Kopasz A couple weeks ago I received an email from Kathie Vaught (Lansing Chapter) suggesting that I do an article about the difference between the Medicare “Wellness visit” and an annual physical examination in our Preventive Care list we have in our Medicare Advantage PPO. Lo and behold a few days later I received an email chain from Kathie, Arva and a SERA member about that subject. Below is Arva’s explanation: Hi Kathie, Thanks for including me in this conversation. Below is some information that may be helpful. Medicare Annual Wellness Visit The yearly “wellness” visit isn’t a physical exam. Medicare Advantage Plan covers this one per calendar year. G0438 (initial wellness visit) and G0439 (subsequent wellness visit) are the two procedure codes providers can select from. During the annual wellness visit the provider will perform an assessment and: Review your medical and family history Review your current providers and prescriptions Develop or update a personal prevention plan based on your current health and risk factors Provide a screening schedule for appropriate preventive services Look for signs of dementia using a cognitive assessment Provide advanced care planning so you’re prepared if you can no longer care for yourself There is no member cost share for the annual wellness visit. If you are receiving other services at the time of this visit (e.g., diagnostic services), you could potentially have member cost share. Medicare Annual Wellness Visit Your provider will perform an age and gender appropriate hands-on exam. Medicare Advantage Plan covers this once per 12-months. Procedure code range for an annual physical exam is 99381-99385 and 99391-99395. There is no member cost share for the annual physical exam. If you are receiving other services at the time of this annual physical (e.g., diagnostic services), you could potentially have member cost share. I hope this information is helpful. Please do not hesitate to contact me if you have any questions. Warm regards, Arva Overton Client Engagement Manager National and Key Accounts Blue Cross Blue Shield of Michigan Editor’s note: Bob Kopasz is Chair of the Michigan SERA Council. He may be reached at P.O. Box 692, Mt. Morris, MI 48458; phone 810/240-8380.
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