Medicare annual wellness visit coding
HCPCS Codes G0438 and G0439
- G0438 – Annual wellness visit (AWV); includes a personalized prevention plan of service (PPS), initial visit
- G0439 – Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit
What is included in an initial AWV with PPPS?
The initial AWV providing PPPS components and the subsequent AWV components can be located by reviewing the following: cms.gov/MLNMattersArticles/downloads/MM7079.pdf
Important notes relating to billing the annual wellness visit:
- If a claim for a G0438 or G0439 is submitted within the first 12 months after the effective date of the beneficiary’s first Medicare Part B coverage, it will be denied as that beneficiary is eligible for the IPPE or “Welcome to Medicare” physical.
- Code G0438 is payable once per lifetime per member regardless of whether or not member had this service with current physician or previous physician. Coded for the initial wellness visit for a member.
- Code G0439 would be payable for each subsequent wellness visit performed for a member.
- Can be coded with other screening services such as G0101, G0102, etc., as long as the services do not overlap.
- Member must have had at least 11 months elapse between annual wellness visits.
Codes cannot be coded in addition to CPT preventive visits 9938x or 9939x (Medicare doesn’t reimburse the preventive CPT codes and requires carve out coding for these services. Priority Health does reimburse this code for our Medicare population so we do not allow carve out services when the CPT preventive codes are billed).
Useful website for education on the new AWV:
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