First it is important to understand the difference between an office visit and an annual/preventive exam...

An office visit addresses specific - new or ongoing health concerns and may involve discussing symptoms, managing chronic conditions, ordering tests, or prescribing medications. Coverage for an office visit varies depending on your insurance and may require a copay or be subject to your deductible.

An annual/preventive exam is a comprehensive review of your overall health and well-being. During this visit, your provider will discuss your current health status, review any existing medical conditions, perform a complete physical examination, and offer personalized recommendations to help you stay healthy. Stable, ongoing medical conditions and routine prescription refills can often be addressed during this visit, as long as no significant changes in treatment or extensive new testing are required. This type of visit is usually covered in full by most insurance plans.

Sometimes both a preventive exam and a new medical issue are addressed in the same appointment. For example, you might come in for your annual physical and also discuss a new concern, such as knee pain. In these cases, your provider is required to bill for both services. Insurance typically covers the preventive portion, while you may be responsible for costs related to the new medical issue.

Insurance companies require us to separate preventive care (your annual exam) from new problem-focused care (like knee pain, stomach issues, or other concerns). Each type of visit has different billing codes.

If your provider addresses both during the same appointment, we are required to submit both codes so:

✅ Your medical record accurately reflects the care you received.

✅ Insurance processes the claim correctly.

✅ Your benefits are applied according to your plan.

Preventive services are usually covered at no cost, while problem-focused services may apply to your deductible or copay.

Why we must bill both services

Since insurance coverage can vary, we encourage patients to contact their insurance provider ahead of time. This helps you feel confident about what is covered and prevents any surprises with billing.