Most insurance companies will cover a well-child physical; however, the vast majority will NOT cover a “sport”, “school”, “camp” (etc.) physical. There are several ways that this can be handled:
1) If it is time for a well-child physical, perform the normal well-child physical and complete any paperwork during that visit. The well-child visit should be coded using CPT 9938x-8839x series along with V20.2 diagnosis code. If the child is eligible for this benefit, the claim should be paid. Most health plans have a limit of one well-child visit per year.
2) If the child recently had a well-child check and, if it is possible to complete the form using the information from the recent well-child check, go ahead and complete the form using that information. This can be done free of charge.
3) The last option is to have the child come to the office for a visit to complete the form and charge a CPT 9920x-9921x series code with a diagnosis code of V70.3. The insurance company will NOT pay for this and the visit should be considered “Time of Service”. The parent should be informed of this fact prior to the visit.