Benefit Change for Medicare Advantage Annual Wellness Visits

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has changed the benefit for payment of the Medicare Advantage Annual Wellness Visit from once every 12 months to once per benefit year. This reconfiguration took effect January 1, 2021 and will remain in place until further notice.  

Key Details

As a result of this change, providers can now schedule Annual Wellness Visits without the previous 12-month timing limitation, which was complicated by delayed scheduling in 2020 due to COVID-19. 

• This update only applies to Medicare Advantage (MA) plans offered and administered by Blue Cross NC, meaning provider offices can begin scheduling Annual Wellness Visits for their Blue Medicare patients for 2021, regardless of the timing of the member’s 2020 Annual Wellness Visit appointments. 
• Additionally, both in-network, out-of-network and Blue Premier providers (including health systems and independent primary care providers) are impacted by this change. 
• Please note, the change is applicable to Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) only. It is not applicable to Prescription Drug Plans (PDP). 

This update is for informational purposes only.