Definition

Medicare covers a yearly appointment to discuss your plan of preventive care in the coming year.

This appointment is called the Annual Wellness Visit (AWV).

The Annual Wellness Visit is similar to the one-time Welcome to Medicare preventive visit but has important differences.

For example, like the Welcome to Medicare visit, the Annual Wellness Visit (Initial Preventative Physical Examination) is not a head-to-toe physical.

However, you cannot receive your Annual Wellness Visit within the first year you are enrolled in Medicare or within the same year you have your Welcome to Medicare exam.

CPT Codes

G0438 – Initial AWW – includes a personalized prevention plan of service (PPPS)
G0439 – Subsequent AWV – updates a personalized prevention plan of service (PPPS)

Components Initial AWV

• Identify risk factors and current medical and mental health conditions  along with related current or recommended treatments
• Check your height, weight, blood pressure, and body mass index
• Screen for cognitive impairment
• Cognitive impairment includes diseases such as Alzheimer’s or other forms of dementia. Medicare does not require that physicians use a test to screen patients. Doctors are asked to rely on their observation of the patient or on reports by the patient and others.
• Review risk factors for depression
• Review your functional ability and level of safety
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living such as bathing and dressing and also your level of safety in your home.
• Give health advice and referrals to health education or preventive counseling services or programs aimed at reducing identified risk factors and promoting wellness
• These include weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

Components Subsequent AWV

• Update the health-risk assessment you completed
• Update medical and family history
• Check weight and blood pressure
• Update list of current medical providers and suppliers
• Screen for cognitive issues
• Update written screening schedule from previous wellness visits
• Update list of risk factors and conditions and the care you are receiving or that is recommended
• Provide health advice and referrals, to health education or preventive counseling services or programs.

Opportunities for additional preventative services

• Advanced Care planning
• Alcohol misuse screening and counseling
• Bone mass measurements
• Cardiovascular dz screening test
• Colorectal cancer screening
• Counselling to prevent tobacco use
• Depression screening
• Diabetes screening
• Diabetes self-management training (DSMT)
• Glaucoma screening
• Hepatitis C virus screening
• HIV screening
• Influenza, pneumococcal, and hep B vaccinations/admin
• IBT for CVD
• IBT for Obesity
• Medical Nutrition Therapy
• Prostate Cancer screening
• Screening for cervical cancer with HPV tests, lung cancer with LDCT, Hep B, sexually transmitted infections, mammography, pap tests and pelvic exam
• High intensity behavioral counselling to prevent STI
• Ultrasound for abdominal aortic aneurysm

Provider can bill for G0506 in addition to the AWV/IPPE billing

Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services and MAY BE ADDED TO AN AWV- but must be seen by a QHCP).

The G0506 code is particularly appropriate when the CCM initiating visit is a less complex visit (such as a level 2 or 3 E/M visit). G0506 can be billed along with higher level E&M visits if the practitioner’s effort and time exceeded the usual effort described in the initial visit E&M code. G0506 can also be billed when the initiating E&M visit addresses problems unrelated to Chronic Care Management and the CCM related work is not included in the initial visit code.

Could be face-to-face and/or non-face-to-face, but the time spent doing the CCM care planning must not already be reflected in the CCM initiating visit itself or in the time spent during the monthly CCM (i.e., in CPT 99490, CPT 99487, CPT 99489)
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G0506 is meant to be billed only once per beneficiary during the initiation of the patient into Chronic Care Management.

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