Preventive Visits CPT Codes 99381-99397

Preventive Visits CPT Codes 99381-99397

Effective January 1, 2016, Independent Health Medicare Advantage plans will no longer offer coverage for routine physicals, which we have historically covered even though they have not been covered under Original Medicare.

Medicare Advantage plans will continue to offer coverage for the Annual Wellness Visits (AWV) as well as the Enhanced Annual Visit (EAV) in the Primary Care Setting.

Claims with dates of service on or after January 1, 2016 for routine preventive visits will be denied as service code not reimbursable.

As noted above, Medicare Advantage plans will continue to cover the following services:

  • Annual Wellness Visit (AWV)
  • Enhanced Annual Visit (EAV)

Please note there are visit requirements in order to receive reimbursement for the Enhanced Annual Visit. For details, please visit

The routine physical exam CPT codes that will no longer be reimbursed beginning in 2016 are 99381-99387 and 99391-99397.

If you have questions about the changes, please contact our Provider Relations Department at (preferred method) or by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.