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Preventive Care Visits

Preventive health visits can be scheduled every calendar year for all Buckeye Health Plan members.

  • Allows members and providers to schedule preventive health visits when it is more convenient
  • Removes barrier of waiting 365 days from last preventive health visit to schedule a new preventive health visit (for ages 2 and up)

Best Practices

  • Consider every visit an opportunity for a preventive visit and an immunization.
  • Review patient charts prior to appointments and allow extra time to complete a preventive visit with a sick visit/sport physical or a sick visit with a preventive visit.
  • Schedule the next preventive health visit during check out.
  • Collaborate with your EHR vendor to incorporate pop-up alerts for preventive services.
  • Send reminder notifications via letter, call, text, or mobile app to your attributed/assigned patients to notify them of the need to schedule an appointment and/or a reminder to attend their scheduled appointment.
    • Do not forget about the patients that have not yet been seen. These patients either chose your office or were assigned to it.
    • Medicaid patients generally need 48 hours to arrange for transportation. So, send reminders 48 to 72 hours prior to appointment.

Points To Keep in Mind

  • If it is the first time a patient will be seen in your office, only one of the two billed visits can be billed as a new patient visit.
    • Ex: A new patient is seen for a preventive health visit. During the preventive health visit, a patient is identified as being sick; so, both a preventive health check and a sick visit are appropriately completed. The preventive health visit is billed as a new patient visit and the sick visit completed with the scheduled preventive health visit is billed with the appropriate E&M as an established patient.
  • If the provider’s documentation supports services for a preventive health visit and a sick visit (with no overlapping documentation components), then separate reimbursement is both warranted and supported.
  • When billing a sick visit on the same day as a preventive health visit, bill the appropriate E&M code (ie 99201-99215) with modifier-25 and preventive code (ie 99381-99397).
  • Preventive health visits for infants and school age children must be in person.

For additional information see our HEDIS Tip Booklet.

When a patient is seen in the office for a preventive visit, as a new or established patient, providers can bill that diagnostic exam as an E&M-25. Providers should reference the most up-to-date sources of professional coding guidance for valid CPT/HCPCS codes.

To receive payment, follow the billing guidelines below taken from the HEDIS Tip Booklet

Important Codes *Codes Subject to Change


Codes      **ICD-10 code cohorts listed                                                                                                                


Well-Care Visits**
First 30 months of life

CPT: 99381-99385, 99391-99395, 99461

HCPCS: G0438, G0439, S0302

ICD-10: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2

Modifier: 25



Well-Care Visits**
3-21 years old

CPT: 99381-99385, 99391-99395, 99461

HCPCS: G0438, G0439, S0302, S0610, S0612, S0613

ICD-10: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z01.411, Z01.419, Z02.5, Z76.1, Z76.2

Modifier: 25



Ambulatory Visits**

CPT: 99201-99205, 99211-99215, 99241-99245,99341-99350, 99381-99387, 99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411-99412, 99483

HCPCS: G0402, G0438, G0439, G0463, T1015

UBREV: 0510-0517, 0519-0523, 0526-0529, 0982-0983

ICD-10: Z00.00, Z00.01, Z00.121, Z00.129, Z00.3, Z00.5, Z00.8, Z02.0-Z02.6, Z02.71, Z02.79, Z02.81-Z02.83, Z02.89, Z02.9, Z76.1, Z76.2

Other Ambulatory Visits with or without Telehealth

CPT: 92002, 92004, 92012, 92014, 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337

HCPCS: S0620, S0621

UBREV: 0524-0525

Telephone Visit

CPT: 98966-98968, 99441-99443

Online Assessment

CPT: 98969-98972, 99421-99423, 99444, 99457, 99458

HCPCS: G0071, G2010, G2012, G2061-G2063, G2250-G2252


Telehealth: 96, GT
Sick and Preventive Visit: 25