August 2018
Preventive Services Reminder: Zero Copay for Blue Cross Medicare AdvantageSM
Are your patients up-to-date on preventive services benefits? Blue Cross and Blue Shield of Texas (BCBSTX) would like to remind you that there are no copays for preventive services for Blue Cross Medicare Advantage (PPO)SM or Blue Cross Medicare Advantage (HMO)SM. Blue Cross Medicare Advantage covers a full range of preventive services to help keep patients healthy, help find problems early and determine when treatment is most effective. You should let members know which of these services is right for them.
For a detailed list of the services with zero copay, access: Are You Up-To-Date on Your Preventive Services?
Additionally, you should check eligibility and benefits electronically through Availity®, or your preferred web vendor.
Annual Health Assessment Coding*
| Code** | Service | Description |
| G0402 | Initial Preventive Physical Examination | Code is limited to new beneficiary during the first 12 months of Medicare enrollment. |
| G0438 | Initial Annual Wellness Visit (AWV) | The initial AWV, G0438, is performed on patients who have been enrolled with Medicare for more than one year, including new or established patients. |
| G0439 | Subsequent AWV | The subsequent AWV occurs one year after a patient’s initial visit. |
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member’s ID card.
*Codes for Annual Health Assessments are subject to change by Medicare Advantage Organization (MAO), without prior notice to Medical Group, for codes to be consistent with Medicare coding requirements for Annual Health Assessments.
**Any updates, deletions and/or additions to coding shall be updated according to nationally recognized coding guidelines.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.