Effective January 1, 2019, or upon plan renewal, PPO and CompMed plans that currently cover the Annual Preventive Health Evaluation (APHE) benefit will be updated to allow the existing annual wellness visit OR a preventive physical exam visit once every 12 months. HPH plans offering a standard Physical Examination benefit will be updated to cover the same APHE benefit (Annual wellness or Physical exam one per 12 months). HPH Plans will cover audiograms (CPT 92551, 92552) and visual acuity test (CPT 99173) at the plan’s diagnostic benefit.
The benefit is limited to members who are 22 years and older. Patients under age 22 have the Well-Child Care visits for routine and preventive care instead of the APHE benefit.
For most plans there is no copayment when a participating provider renders the services. For members enrolled in PPO and CompMed plans, when a nonparticipating provider performs the APHE, payment will be made according to the plans outpatient physician benefit.
Visits should include referrals to appropriate screening services as needed.
Refer to Hawaii Healthcare Information Network (HHIN+) to check the availability of benefits and applicable coverage levels.
Billing Instructions
Please bill the Annual Preventive Health Exam (APHE) or Physical Exam (PE) visit annually using one of the following procedure codes:
| HCPCS code | Description |
|---|---|
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit |
| G0439 | Annual wellness visit; includes a personalized prevention plan of service (PPS), subsequent visit |
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years |
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years |
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years. |
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |