Effective Monday, August 15, 2016:

CHPW has added a new value-added benefit that covers annual sports physical exams for Apple Health kids age 6 -18 at no cost to the member.

When possible, we encourage you to schedule a well-care visit with the sports physical exam.

Guidance for Billing Sports Physical Exams:
ICD-10-CM diagnosis code Z02.5 - Encounter for examination for participation in sport 
CPT code 99212 - Office or other outpatient visit for the evaluation and management of an established patient. This requires at least two of these three key components be present in the medical record: 

  • A problem focused history
  • A problem focused examination;
  • Straightforward medical decision making

Modifier 25 – should be used when the sports physical is combined with a well-care preventive visit.