Preventive Services: Annual Wellness Visit (AWV)

by  Find-A-Code
September 1st, 2017

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Annual Wellness Visits (AWV):

HCPCS/CPT Codes

G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit
G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit
99497 - Advance care planning 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 - Advance care planning 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)

ICD-10 Codes

See the CMS ICD-10 webpage for individual CRs and coding translations for ICD-10, and contact your MAC for guidance.

Who Is Covered

All Medicare beneficiaries who are both:

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

Frequency

  • Once in a lifetime for G0438 (first AWV)
  • Annually for G0439 (subsequent AWV)
  • Annually for optional 99497, 99498

Medicare Beneficiary Pays

G0438 and G0439:

  • Copayment/coinsurance waived
  • Deductible waived

99497 and 99498:

  • Copayment/coinsurance and deductible waived for Advance Care Planning when furnished as an optional element of an AWV

Other Notes


Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.

References:

Preventive Services: Annual Wellness Visit (AWV). (2017, September 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/annual-wellness-visit-awv-32696.html

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