Medicare Part B beneficiaries are allowed one Medicare Annual Wellness visit (AWV), which provides Personalized Prevention Plan Services (PPPS), if the beneficiary has had Medicare Part B for 13 months or more and they have not had their Initial Preventive Physical Exam (IPPE) or an AWV within the past 12 months. There are certain components that must be included in an AWV per Medicare guidelines and below you will find all the necessary components that are needed.
For the initial AWV:
Administer Health Risk Assessment (HRA). At minimum this should include: demographic data, self-assessment of health status, psychosocial risks, behavioral risks, activities of daily living (ADLs) including but not limited to: dressing, bathing and walking, and instrumental ADLs including but not limited to: shopping, housekeeping, managing own medications and handling finances. (This is a brief summary of the minimum requirements. Refer to the Centers for Disease Control and Prevention's (CDC's) publication here for more information).
Establish a list of current providers and suppliers. Include any provider or supplier that regularly provides medical care to beneficiary.
Gather beneficiary's medical/family history. This includes: medical events of the patient's parents, siblings and children including and hereditary diseases or anything that puts the patient at increased risk.
Depression screening. Use appropriate screening test for patient's without a current diagnosis of depression. Include current or past experiences with depression or any mood disorder.
Review beneficiary's functional ability and level of safety. By direct supervision or by appropriate screening questions assess, at minimum, the following: Ability to perform ADLs successfully, fall risk, hearing impairment and home safety.
Exam. Medical records must include: Height, weight, BMI (or waist circumference) and blood pressure.
Cognitive detection. Assess by direct observation the patient's cognitive function with consideration of information gathered by the patient reports and concerns raised by family, friends and caretakers.
Generate written screening. Base written screening, such as a checklist for the next 5 to 10 years, on age-appropriate Medicare preventative services, recommendations from the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP).
Establish list of risk factors and conditions. Including: mental health conditions, risk factors noted in the patient's IPPE and treatment options along with associated risks and benefits
Provide personalized health advice and referrals. Referrals to educational and counseling services or programs aimed at lifestyle changes which reduces health risks and promotes self-management and wellness including: fall prevention, nutrition, physical activity, tobacco-use cessation and weight loss.
Advance care planning at the beneficiary's discretion. Discussion about care decisions that may need to be made in the future, how the patient can notify others about their care preferences and explain advance directives including the forms that are required.
All Subsequent AWVs (all AWVs after the initial):
Update Health Risk Assessment (HRA). Review and update the HRA obtained in the initial AWV.
Update current providers and suppliers. Review and update the list of providers and suppliers obtained in the initial AWV.
Update beneficiary's medical/family history. Review and update the patient's medical and family history obtained in the initial AWV.
Exam. Medical records must include: Height, weight, BMI (or waist circumference) and blood pressure.
Cognitive detection. Assess by direct observation the patient's cognitive function with consideration of information gathered by the patient reports and concerns raised by family, friends and caretakers.
Update written screening. Review and update the written screening schedule for the patient that was generated in the initial AWV.
Update list of risk factors and conditions. Review and update the list of risk factors and conditions noted in the initial AWV.
Provide personalized health advice and referrals. Referrals to educational and counseling services or programs aimed at lifestyle changes which reduces health risks and promotes self-management and wellness including: fall prevention, nutrition, physical activity, tobacco-use cessation and weight loss.
Advance care planning at the beneficiary's discretion. Discussion about care decisions that may need to be made in the future, how the patient can notify others about their care preferences and explain advance directives including the forms that are required.
Once all the above components are completed for the Initial AWV and Subsequent AWV's, a Medicare Part B participating provider can bill Medicare for reimbursement. Here are the HCPCS codes used to file AWV claims:
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
Advance Care Planning (ACP) is an optional service providers can offer to their patients. This service includes a face-to-face discussion of the patient's wishes and preferences for medical treatment if he or she was unable to speak or make decisions in the future. If this service is provided and documented providers may bill the following CPT codes in addition to the AWV.
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 care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
99498 - each additional 30 minutes (list separately in addition to 99497)
Billing note: Medicare will waive both coinsurance and Part B deductible if the ACP is done on the same day as a covered AWV, furnished by the same provider as the AWV, is billed with modifier 33 (preventive service) and is billed on the same claim as the AWV.
A preventative ICD-10 code (Z00.00 or Z00.01) is usually billed with these HCPCS/CPT codes but you are not required to send a specific ICD-10 and therefore, you may choose any ICD-10 code that is consistent with the patient's exam.
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