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):
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)
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
- Once in a lifetime for G0438 (first AWV)
- Annually for G0439 (subsequent AWV)
- Annually for optional 99497, 99498
Medicare Beneficiary Pays
- Copayment/coinsurance waived
- Deductible waived
- Copayment/coinsurance and deductible waived for Advance Care Planning when furnished as an optional element of an AWV
- For services furnished on or after January 1, 2016, Advance Care Planning is treated as an optional preventive service when furnished with an AWV.
- The deductible and coinsurance for Advance Care Planning is only waived when furnished as an optional element of an AWV, which requires:
- Billing with modifier -33 on the same claim as an AWV
- Furnishing on the same day and by the same provider as the AWV
- Refer to The ABCs of the Annual Wellness Visit for more information.
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.