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Medicare G0438 – G0439: Two Annual Wellness Visit Codes

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Medicare Benefit: Annual Wellness Visits Covered

Back on January 1, 2011, Medicare started to provide coverage for Annual Wellness Visits. This benefit was included in the Affordable Care Act of 2010. Medicare has two HCPCS codes for these wellness visits for medical billing purposes. The codes are G0438 and G0439.

G0438 Annual Wellness Visit, Initial (AWV)

Annual wellness Visit, including a personalized prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV)

Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit. Annual Wellness Visits can be for either new or established patients as the code does not differentiate. The initial AWV, G0438, is performed on patients that have been enrolled with Medicare for more than one year. A patient is eligible for his subsequent AWV, G0439, one year after his initial visit. Remember that during the first year a patient has enrolled with Medicare, he is eligible for the Welcome to Medicare visit or Initial Preventative Physical Exam (IPPE). This exam is billed using HCPCS code G0402. An Annual Wellness Visit code of G0438 should not be used — and will be denied — because the patient is eligible for the Welcome to Medicare visit during the first year of enrollment. For more information on the Welcome to Medicare visit go to CMS.

What is included in an Initial AWV with PPPS?

  • Medical and family history
  • List of current medical providers
  • Height, weight, BMI, BP and other appropriate routine measurements
  • Detection of cognitive impairment
  • Review risk factors – Review of functional ability
  • Establish a written screening schedule for next 5-10 years
  • Establish list of risk factors
  • Provide advice and referrals to health education and preventative counseling services
  • Other elements as determined by the Secretary of Health and Human Services

The above list is just a summary. Check out MLN Matters Number MM7079 for additional information and links to other Medicare resources on services that must be provided at the AWV and subsequent AWV. Preventative Medicine codes 99387 and 99397, better known to offices as Complete Physical Exams or Well Checks for 65 and older, still remain a non-covered, routine service from Medicare. The Well Woman Exam codes G0101 and Q0091 are covered services.

For additional information, specifics, and more details, visit the CMS or your local Medicare carrier’s website. You can also contact them directly.

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is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

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447 Responses to Medicare G0438 – G0439: Two Annual Wellness Visit Codes

  1. Please help. My provider was told at a meeting recently that all GCODES can be done by a RN or certified Medical Assistant. He is under the impression IPPE and AWV can be done by them in office as long as he is here in the suite. Please advise.

    • My limited understanding is that they can do part of it, but the NP or MD must be the one to make the plan and recommendations in order to bill medicare.

    • Hi Nicole —

      The following info is from CMS:

      Who can perform an Annual Wellness Visit?
      Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a:
      • Physician (doctor of medicine or osteopathic medicine)
      • Physician assistant
      • Nurse practitioner
      • Clinical nurse specialist
      • Medical professional (including a health educator, a registered dietitian, nutrition professional,
      or other licensed practitioner) or a team of such medical professionals working under the direct
      supervision of a physician (doctor of medicine or osteopathy)

      Who can perform an Initial Preventive Physical Exam?
      Medicare Part B covers an Initial Preventive Physical Exam if it is furnished by a:
      • Physician (doctor of medicine or osteopathic medicine), or
      • Other qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical
      nurse specialist)

      For the AWV after the RN completes the questionnaire the Physician should then review the questionnaire with the patient and come up with the personalized prevention plan of service for the patient.

      Check with your local Medicare carrier for specific information.

      SOURCE: https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf

      Hope this helps.

  2. Please help me with this debate. A group of providers is telling my provider that all Gcodes can be done by a Certified Medical Assistant or RN. Provider is being told AWV,IPPE can be done by them as long as he is in the suite. Please advise 🙂

  3. Does anyone know if you can bill for Advance Care Planning 99497 as a “stand alone” visit with out an office visit charge, or any other charge, or any modifier, and be paid for it? I had a patient come in with an Advance Care Plan he created at home and he wanted me to see it. I looked at it and made some changes to it with him, but nothing else was done. Thank you!

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