26-084 Commercial Plans Will No Longer Accept Medicare-Specific G-Codes Starting April 1, 2026
Date: 01/26/26
Action required: Use standard preventive CPT codes for Commercial members
Beginning April 1, 2026, Ambetter HMO and PPO, and Employer Group HMO/POS and PPO (Commercial) plans will no longer accept the Medicare‑specific G‑codes G0402, G0438, and G0439. Providers must bill standard preventive CPT codes for members enrolled in Commercial plans.
Why this change
These G‑codes are designated for Medicare beneficiaries under Centers for Medicare & Medicaid Services program rules and cannot be applied to Commercial benefit plans.
What this means for you
- Do not submit G0402, G0438 or G0439 for Commercial plan members.
- Use standard preventive visit CPT codes based on patient age and visit type.
- Verify benefits and eligibility prior to the visit to ensure correct billing.
- Claims billed with the Medicare‑specific G‑codes for Commercial plan members on or after April 1, 2026, will be denied.
Billing guidance and codes affected
The Medicare‑specific codes below will no longer be accepted for Commercial plans. Please use the corresponding preventive CPT codes instead:
CPT Copyright 2025 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
Codes no longer accepted (Medicare‑specific) | Use instead for Commercial plan members |
|---|---|
G0402 – Initial preventive physical exam (IPPE) | 99381–99387 − Preventive visit, new patient |
G0438 – Annual wellness visit (initial) | 99391–99397 − Preventive visit, established patient |
G0439 – Annual wellness visit | 99391–99397 – Preventive visit, established patient |
Need help? Contact us
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
Provider Services
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO |
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.