decisionhealth Newsletters, Part B News - 2015 Issue 11 (November)
AWV plus a physical: Medicare says don’t bill both at full cost
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Article Overview
This brief Part B News article discusses Medicare’s handling of same-day annual wellness visits and preventive medicine exams, including how coverage and patient responsibility may be affected when both services are provided together. It is aimed at billing and coding staff, practice managers, and clinicians who need to understand Medicare payment rules, preventive-service coverage, and related administrative considerations such as secondary insurance and beneficiary notices.
Why This Topic Matters
Same-day preventive services can create billing and payment questions for Medicare beneficiaries, especially when one service is covered and the other is not. Understanding the article helps practices avoid billing mistakes and better manage patient charges, claim routing, and compliance with Medicare policy.
What You Will Learn
- How Medicare views same-day annual wellness visits and preventive medicine exams
- How overlapping preventive and wellness-service components affect billing considerations
- What role secondary insurance may play when a preventive service is non-covered
- When beneficiary notice requirements may or may not apply in this context
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Primary care clinicians
- Compliance staff
Codes Discussed
Code Ranges Discussed
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