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Women’s Preventive/Wellness Visits
Women may choose to see either their primary care physician or obstetrician/gynecologist (OB-GYN) for preventive/wellness visits. The ICD-10 diagnosis code is the key to making sure benefits are applied correctly. Refer to the chart below for guidance.
|
Service Provided By |
ICD-10 Codes for Preventive/Wellness Visits |
|---|---|
| Primary Care Physician | Z00.00 or Z00.01 |
| Obstetrician/Gynecologist | Z01.411 or Z01.419 |
When appropriate, members will receive benefits for both encounters.
Many members have benefits for one visit each year for a preventive history and physical examination.* In addition, benefits are available for two visits through Women’s Preventive Services Guidelines. See our Preventive Care Services webpage for more information.
The following are guidelines for filing claims for a new patient versus an established patient.
Women’s Preventive Services Guidelines
| Number of Visits Covered | CPT or HCPCS Code | ICD-10 Code | |
|---|---|---|---|
| Established Patient | Two per calendar year | 99393-99397, G0439, S0612 or S0613 |
Z00.00 - Encounter for general adult medical examination without abnormal findings Z00.01 - Encounter for general adult medical examination with abnormal findings Z01.411 - Encounter for gynecological examination (general/routine) with abnormal findings OR Z01.419 - Encounter for gynecological examination (general/routine) without abnormal findings |
| New Patient | Two per calendar year; can only be billed once by the same provider |
99383-99387, G0438 or S0610 99383-99387, G0438 or S0610 |
Z00.00 or Z00.01 – limited to one per calendar year Z01.411 OR Z01.419 – limited to one per calendar year |
There should be no cost for members in Affordable Care Act (ACA)-compliant plans for these services.
*Female members who have ACA-compliant plans have benefits for more than one preventive/wellness visit per year. Be sure to check the member’s eligibility and benefits to verify their plan is ACA-compliant. Blue Advantage® plans do not have benefits for more than one preventive/wellness visit per year.
For a printable copy of this information, view our Women's Preventive Services flier.