Back on January 1, 2011, Medicare commenced to offer insurance for Annual Wellness Visits. This benefit  turned into covered withinside the Affordable Care Act of 2010. Medicare has HCPCS codes for Annual wellness visit  visits for clinical billing purposes. The codes are G0438 and G0439.


CPT  Code G0402 Medicare

Initial Preventive Physical Examination (IPPE) or Welcome to Medicare Visit

G0438 Annual Wellness Visit, Initial (AWV)

Annual wellness visit, along with a customised prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV)

Annual Wellness visit , along with a customised prevention plan of service (PPPS), next visit. Annual Wellness Visits may be for both new or mounted patients because the code does now no longer differentiate.

Who is eligible for the AWV-G0438 & G0439?

Medicare covers an AWV for all beneficiaries who are not  inside one year after the powerful date in their first Medicare Part B insurance period, and who’ve now no longer had both an IPPE or an AWV withinside the beyond one year. Medicare can pay for the handiest one first AWV in keeping with beneficiary in keeping with lifetime and one next AWV in keeping with 12 months thereafter.

The preliminary AWV, G0438, is done on patients which have been enrolled with Medicare for multiple 12 months. Patient is eligible for his next AWV, G0439 requirements , 12 months after the preliminary visit. Remember that in the primary 12 months a patient  has enrolled with Medicare, Who’s eligible for the Welcome to Medicare Visit or Initial Preventive Physical Exam (IPPE).

This consideration is billed for the usage of HCPCS code G0402. An Annual Wellness Visit code of G0438 requirements should not be used — and can be denied — due to the fact the patient is eligible for the Welcome to Medicare Visit in the course of the primary 12 months of enrollment. For extra statistics at the Welcome to Medicare Visit  CMS.

Billing Codes
Billing Codes

What is covered in an Initial AWV with PPPS?

  • Medical and own circle of relatives history
  • List of present  clinical providers
  • Height, weight, BMI, BP, and different suitable recurring measurements
  • Detection of cognitive impairment
  • Review risk factors – Review of useful ability
  • Establish a written screening agenda for the subsequent 5-10 years
  • Establish a listing of risk factors
  • Provide recommendation and referrals to fitness training and preventative counseling offerings
  • Other factors as decided via way of means of the Secretary of Health and Human Services

Who Is Covered?

All Medicare beneficiaries who’re both:

  • Not inside one year after the powerful date in their first Medicare Part B insurance period
  • Have now no longer obtained an Initial Preventive Physical Examination (IPPE) or AWV withinside the beyond one year
  • Frequency
  • Once in an entire life for G0438 (first AWV)
  • Annually for G0439 (next AWV) Medicare Beneficiary Pays
  • Copayment/coinsurance waived

Medical Billing Services- G0438 & G0439 That Maximize Reimbursements

Some of the reasons physicians are disturbed with their in-home or outsourced billing are because of billing staff inexperience or negligence and turnover. This can cause claims to be submitted incorrectly, a few claims are not submitted at all, rejected claims, denied claims, coding errors, loss of follow-up on unpaid claims and no billing patients frequently for deductibles and coinsurance.  All ensuing in a huge mess and the exercise dropping money.

Practitioners Reimbursement
Practitioners Reimbursement

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