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Annual wellness visits (AWVs)

An annual wellness visit (AWV) is covered for all Medicare beneficiaries who:

  • Are not within 12 months after the effective date of their first Medicare Part B coverage period and
  • Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months.

HCPCS and CPT codes

G0438 -- Initial visit (once in a lifetime)

G0439 -- Subsequent visit (annually)

G0468 -- Federally qualified health center (FQHC) visit, IPPE or AWV; a FQHC visit including an IPPE or AWV and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV

99497 -- Advance care planning (ACP) including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate

99498 -- ACP including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

G0136 -- Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months.

Deductible, coinsurance and modifiers

G0438 and G0439:

  • No copayment, coinsurance, or deductible

G0468:

  • You must provide an AWV or IPPE with a standard bundle of services available to all patients
  • No copayment, coinsurance, or deductible

99497 and 99498:

  • Deductible and coinsurance for ACP is only waived when furnished as an optional element of an AWV, which requires:
    • Billing with modifier -33 (Preventive Service) on the same claim as an AWV
    • Furnished on the same day and by the same provider as the AWV

G0136:

  • Deductible and coinsurance is only waived when furnished as an optional element of an AWV, which requires:
    • Billing with modifier -33 (Preventive Service) on the same claim as an AWV
    • Furnished on the same day and by the same provider as the AWV

Frequency

  • Once in a lifetime for G0438 (first AWV).
  • Annually for G0439 (subsequent AWV) and G0468 (AWV in FQHC)
  • Annually for optional 99497, 99498
  • Every 6 months for G0136 if billed with a qualifying visit (annually when billed with AWV)

Notes

ACP is treated as an optional preventive service when furnished with an AWV.

  • Practitioners may provide ACP outside of the AWV multiple times in a year, but the practitioner must document a change in the beneficiary’s health for each additional service in a year.

  • When providing ACP outside the AWV, the beneficiary is responsible for the deductible and coinsurance.

 

References