Summary & Overview
HCPCS S5190: Wellness Assessment, Non-Physician
HCPCS Level II code S5190 designates a wellness assessment performed by a non-physician clinician. As preventive care and team-based primary care expand, this code matters for documenting non-physician contributions to early identification of health risks and routine wellness services on a national scale. Payers increasingly recognize non-physician-led preventive encounters as part of value-based care and population health management.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what S5190 represents, how it fits into ambulatory and community-based preventive care, and the payer landscape addressed in the analysis. The publication provides benchmarks where available, notes on policy and coverage patterns, and clinical context to help billing, compliance, and clinical teams understand documentation expectations and service settings. Data not available in the input for detailed associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
HCPCS Level II code S5190 represents a wellness assessment, performed by a non-physician. This service typically involves a structured evaluation of a patient’s general health, preventive needs, and risk factors conducted by qualified non-physician clinicians such as nurse practitioners, physician assistants, health coaches, or other allied health professionals.
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Service type: Preventive wellness assessment
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Typical site of service: Outpatient clinic, primary care office, community health center, or other ambulatory care settings where non-physician providers deliver preventive services
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult established in primary care presenting for a routine preventive visit or a focused wellness check performed by a non-physician clinician, such as a nurse practitioner, clinical nurse specialist, physician assistant, or licensed clinical social worker. The patient may be asymptomatic or report general health concerns (sleep, mood, weight, medication side effects). The non-physician conducts a structured wellness assessment including medical history review, medication reconciliation, preventive screening review (immunizations, cancer screening status), brief behavioral health screening (PHQ-2/PHQ-9 or similar), social determinants screening (housing, food security), vital signs, and counseling on lifestyle modification. Relevant documentation includes reason for visit, assessment findings, risk factor summary, preventive care gaps, brief problem-focused exam or directed physical assessment as appropriate, and a plan (referrals, screenings ordered, patient education). When indicated, the non-physician documents coordination with the supervising physician and orders necessary tests or referrals under standing orders or collaborative practice agreements. Typical site of service is an outpatient clinic, community health center, or ambulatory care setting. Common patient scenarios include annual wellness check for a middle-aged patient, medication follow-up for a chronic condition managed primarily by the non-physician, or behavioral health screening and brief intervention in primary care.
Coding Specifications
| Modifier | Description | When to Use |
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