Important Information about Routine Physical Exams for Medicare Advantage Members

In the years following the “Welcome to Medicare” physical exam, Humana Medicare Advantage members are covered for a routine physical by a single physician once per 365 days at no cost (as long as applicable in-network requirements are met). Please refer to the following information for more details:

Physical Exam (Routine)

This routine physical includes the following components:

  • Review of medical history and a physical examination to identify risk status and to manage any interventions that are needed
  • Counseling on diet, exercise, substance abuse and injury prevention
  • Recording of height and weight at intervals according to the health care provider’s clinical discretion
  • Blood pressure check every two years after age 21
  • Vision screening at the health care provider's discretion
  • Hearing screening at the health care provider's discretion

1. Q: Is the Humana Medicare Advantage routine physical exam the same as the "Welcome to Medicare" initial physical exam?

A: No. A routine physical is not the same as the "Welcome to Medicare" exam for Medicare Advantage members. The "Welcome to Medicare" exam is allowed once per lifetime within the first 12 months of Medicare Part B enrollment. The routine physical exam is allowed once in addition to the "Welcome to Medicare" exam during the first 12 months of Medicare Part B enrollment, and then once per 365 days in the years following the "Welcome to Medicare" physical.

2. Q: Which billing codes should I use for the routine physical exam?

A: New patient preventive medicine visits (routine physicals) are billed with American Medical Association (AMA) Current Procedural Terminology (CPT®) codes 99381-99387. Established patient preventive medicine visits (routine physicals) are billed with CPT codes 99391-99397.

3. Q: How often can my patient with Humana Medicare Advantage coverage receive a routine physical exam?

A: Routine physical exams are allowed once per 365 days for Humana Medicare Advantage members.

4. Q: What if it has not been 365 days since my patient's last routine physical?

A: A routine physical exam is allowed once during a 365-day period for Humana Medicare Advantage members. If a patient with Humana Medicare Advantage coverage receives more than one routine physical exam from any physician during a 365-day period, the subsequent routine physical exam will not be covered.

5. Q: Will a routine physical be allowed by more than one physician during the 365-day period since the patient's last routine physical?

A: No. A routine physical exam is allowed from one physician once during a 365-day period for Humana Medicare Advantage members. If a patient with Humana Medicare Advantage coverage receives more than one routine physical exam from any physician during a 365-day period, the subsequent routine physical exam will not be covered.