All PlansCoverageMedium impact
Make Summer Plans for Dental and Wellness Visits
EmblemHealth·Pediatrics, Family Medicine, General Practice·Provider News
We identified it
Jun 20, 2026
Summary
Well-child visits no longer require a 365-day waiting period between visits, allowing more frequent wellness visits when children come in for other services. Telehealth can be used for well-child visit compliance but requires the GT modifier, though it cannot be used for HEDIS Well-Child visit measures.
Action Required
Immediately: Update billing workflows to allow well-child visits without 365-day waiting periods. Add separate and distinct service modifiers when conducting well-child visits during illness visits. For telehealth well-child visits, ensure GT modifier is added to appropriate CPT codes. Train providers on new flexibility for scheduling wellness visits.