CommercialCoverageMedium impact
Behavioral Health Wellness Exams
EmblemHealth·MA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider News
Effective date
Mar 31, 2024
We identified it
Jun 20, 2026
Summary
ConnectiCare will now cover behavioral health wellness exams once per year with no cost-share starting March 31, 2024. The billing team must use specific CPT code 90791 with diagnosis Z13.30 and modifier 33 to ensure proper coverage.
Action Required
By March 31, 2024: Billing team must update system to recognize CPT 90791 with diagnosis Z13.30 and modifier 33 for ConnectiCare behavioral health wellness exams. Update billing software to flag this as a covered preventive service with no patient cost-share when billed annually. Train staff on new billing requirements and update encounter forms to include modifier 33 option.