Medicare AdvantageBilling CodesMedium impact
Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day
Medical Mutual of Ohio·Family Medicine, Internal Medicine, General Practice +1 more·Coding
We identified it
Jun 20, 2026
Summary
Medical Mutual updated guidelines for billing both wellness visits and sick visits on the same day for Medicare Advantage patients. When treating acute problems during an annual wellness visit, providers can bill both the wellness code (G0402, G0438, or G0439) and a problem-oriented visit code (99202-99215) but must add modifier 25 to the sick visit code only.
Action Required
Immediately: Update billing system to automatically add modifier 25 to problem-oriented visit codes (99202-99215) when billed same day as wellness visits (G0402, G0438, G0439). Train providers to document separate work justifying both visits and inform patients when additional services are being billed. Never add modifier 25 to wellness codes or vaccines.