Aetna Medicare Advantage (MA) plans now cover an annual wellness visit; no longer cover annual physicals

 

Effective January 1, 2013, Aetna MA plans include coverage for an annual wellness visit. The CPT codes for a wellness visit are G0438 and G0439.

 

Aetna MA plans no longer cover annual physical exams. The CPT codes for the annual physical exam are 99381-99397, 99401-99404, 99201-99205 and 99211-99215 with primary diagnosis of preventive. The preventive diagnosis codes that are not covered are:

 

*     V03.0-V03.9

*     V04.0-V04.89

*     V05.0-V05.9

*     V06.0-V06.9

*     V20.0-V20.2

*     V70.0

*     V70.3

*     V70.5

 

This change was made as a result of a change in coverage made by the Centers for Medicare and Medicaid Services (CMS).

 

To avoid claims rejection, please bill appropriately for annual wellness exams.

 

If you have additional questions about these codes, you can also contact our Provider Service Center at 1-800-624-0756 for HMO-based and Medicare Advantage plans.