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Free Sports Physicals

December 24, 2018

Effective July 1, 2018, Healthy Blue now offers an extra benefit for our members each benefit year (July 1 – June 30): We will reimburse one sports physical per benefit year for members between the ages of 6–18. Additionally, we now pay in-network PCPs, including nurse practitioners and physician assistants billing with their own NPIs, to perform sports physicals for our members.

Please pass this information along to your staff.

How do I bill for the sports physical?

There are two scenarios to consider:

1. If the member has had a well-child exam this year, simply bill using CPT code 99212 with modifier 8P and diagnosis code Z02.5 for the sports physical claim. By performing a sports physical, you will receive reimbursement of $30.

2. If the member has not had a well-child exam this year, you can bill for a well-child visit, the well-child incentive and a sports physical:

  • To bill for the well-child visit, use the appropriate codes (99383, 99384, 99393, 99394) with modifier 25 and the diagnosis code (Z00.0X, Z00.1XX, Z00.X, Z02.X, Z02.71, Z02.79, Z02.8X). The primary diagnosis pointer for the well exam must point to one of the above diagnosis codes.
  • To bill for the $30 well-child incentive, bill CPT code G9153 with one of the well-child diagnosis codes listed above. Insert it on the claim line directly below the line with the well-child CPT code. The primary diagnosis pointer for CPT code G9153 should also point to one of the diagnosis codes listed.
  • To bill for the sports physical, use CPT code 99212 with modifier 8P and diagnosis code Z02.5. The primary diagnosis pointer for 99212 must point to diagnosis code Z02.5. By performing a sports physical, you will receive a reimbursement of $30.

Have any questions?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call our Customer Care Center at 866-757-8286.

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