Priority Health members with a wellness plan (Thrive and Thrive Plus) have a number of extra preventive benefits, including a $0 annual skin check. Please remember that this benefit only covers a skin cancer screening by a dermatologist . If anything besides this screening is done at the visit, the member may incur a cost.
What do providers need to know about $0 skin checks?
Only PriorityMedicare Thrive and PriorityMedicare Thrive Plus members have the $0 skin check benefit. All other PriorityMedicare plans (other than D-SNP and Dual Premier) require member cost shares for skin cancer screenings.
Dermatology practices performing the skin checks: ensure you’re billing the proper Z code to ensure the skin check does not result in a specialist copay.
If anything besides a skin check is done at the visit, the member may incur a cost. If members request other treatment at the visit besides a skin check, let them know the service(s) would be outside the $0 skin check benefit and may lead to charges being billed to them.
What about other Medicare benefits?
Visit the Medicare Advantage plan benefits page on our Provider Manual for an overview of services covered by both Priority Health Medicare plans and Original Medicare—as well as Summaries of Benefits for all PriorityMedicare plans.