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Billing and Reimbursement Guidelines: Well and Sick Visits on the Same Date of Service

Providing a sick (E/M) visit and a well visit at the same appointment can be done with all five Medicaid managed care plans by using the -25 modifier; however, reimbursement amounts vary by plan. The following table has been updated and outlines what you can expect from each plan when billing a well and sick visit together: 

If you have questions or billing issues, please contact Provider Relations Specialists Michelle Bronner at Michelle.Bronner@NationwideChildrens.org or Bob Pastva at Robert.Pastva@NationwideChildrens.org.

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