by Wyn Staheli, Director of Research
August 1st, 2017
Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.
These exams are sometimes referred to as well baby, well-child or well-adult visits. They include:
- An age-and gender-appropriate history
- Physical examination
- Counseling/anticipatory guidance
- Risk factor reduction interventions
- The ordering of appropriate immunization(s) and laboratory/screening procedures
Even though all payers cover an AWV, be aware of individual payer requirements regarding which services must be performed and documented as part of the visit. For example, Medicare's AWV requires a Personalized Prevention Plan of Service (PPPS) and a Health Risk Assessment. Medicare also states that the AWV is not the same thing as their Initial Preventive Physical Examination (IPPE) or an annual routine physical checkup.
NOTE: typically allowed with any diagnosis code since this is a well visit however, be aware of individual payer requirements before billing.
During the AWV, additional preventive services may also be performed and billed separately - where appropriate. For example, if during the Health Risk Assessment portion, tobacco use was identified, the healthcare provider may provide tobacco use cessation counseling and bill that service in addition to the AWV code. Keep in mind that additional services provided beyond the AWV are covered at the payers typical rate. Co-pays and/or deductibles may apply.
The following are some commonly covered preventive care services which may also be provided during the AWV and are billed separately from the AWV.
- Health Risk Assessment (e.g., 96160, 96161)
- Depression screening (e.g., G0444, 96127)
- Alcohol and substance abuse/misuse screening/counseling (e.g., 99408, 99409, G0396, G0397, G0442, G0443)
- Autism screening (e.g., 96110)
- Blood pressure screening (e.g., 93784, 93786, 93788, 93790)
- Domestic and interpersonal violence screening/counseling
- Hearing and vision screening (e.g., 92551, 99173, 99174, 99177)
- Counseling/education regarding contraception methods for women (e.g., 99381-99397)
- Obesity screening/counseling regarding weight loss, healthy diet and exercise (e.g., 97802, 97803, 97804, S9470, G0446, G0447, G0473)
- Counseling to prevent initiation of tobacco use (e.g., 99401, 99402, 99403, 99404, 99411, 99412)
- Psychosocial/Behavioral assessment (e.g., G0451, 96110, 96127, S0302)
- Counseling related to sexual behavior/sexually transmitted infection (STI) prevention (e.g., G0445)
- Smoking and Tobacco use screening/counseling (e.g., 99406, 99407, G0436, G0437)
- Heart disease screening (e.g., 80061, 82465, 83718, 83719, 83721, 84478)
- Immunizations (e.g., 90620-90748, Q2034-Q2039)
- Laboratory tests