AWV denial rates increase when visits billed with modifier 25

Why This Topic Matters

Denials tied to wellness visits can affect reimbursement, claim processing workload, and documentation review priorities for practices that frequently bill preventive services alongside evaluation and management services.

Article Sections

1. Benchmark of the week

   Introduces the denial-rate benchmark for annual wellness visits and summarizes the article’s focus on claims billed with modifier 25. It frames the comparison across specialties and visit types.

2. Denial rates for initial AWVs with and without modifier 25 in 2012

   Presents comparative denial-rate information for initial annual wellness visits using CMS-derived data. The section focuses on specialty-level patterns and reporting variations.

3. Denial rates for subsequent AWVs with and without modifier 25 in 2012

   Presents comparative denial-rate information for subsequent annual wellness visits using CMS-derived data. The section highlights how denial patterns differ from the initial-visit benchmark.