Bill Medicare for Preventative Visits

Effective January 1, 2011, CMS is expanding their coverage to include AWV’s (Annual Wellness Visit) which will include PPPS (Personal Preventative Plan Services) for members who are no longer within their 12 month effective date of their first Medicare Part B coverage. As customary with preventive services Coinsurance and Part B deductibles do not apply. The AWV will have to include establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index (BMI) or waist circumference, and blood pressure (BP), with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B

New HCPCS codes:

G0438 – AWV with PPPS – first

G0439 – AWV with PPPS - subsequent

Billing Reminders:

G0348 is for the FIRST AWV only

G0348 or G0439 cannot be billed within 12 months of:

Each other

Previous billing of G0402 (IPPE – Welcome to Medicare Visit)

Effective date of members first Medicare Part B coverage.