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An AWV is a detailed, question-based assessment of a patient’s current health and risk factors and is free for patients with Medicare Part B.
The goal of AWVs is to create a complete personal and family health history for patients and help prevent future health problems.
Health care professionals who may administer and bill AWV include:
This visit is offered to patients within 12 months after enrolling in Medicare.
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Billing code G0402 is for the Initial Preventive Physical Examination (IPPE). This visit is offered to patients within 12 months after enrolling in Medicare. They can only receive this benefit once. The reimbursement is around $163.
Billing code G0438 is for the Initial Annual Wellness Visit. This visit is offered to patients only once in their lifetime. They are eligible within 11 calendar months after their IPPE. The reimbursement is around $162.
Billing code G0439 is for the Subsequent Annual Wellness Visit, Patients are eligible for this benefit every year after their Initial Annual Wellness Visit. The reimbursement is around $128.
Before starting a program, it's important to consider:
Apart from understanding AWV's rules and requirements, providers should:
Organize a multidisciplinary team of qualified providers to support a comprehensive AWV program, and determine appropriate roles and responsibilities.
Find eligible AWV patients by targeting specific conditions or populations, working with specialists and primary care partners, or reviewing current EHR records.
Acquire a digital platform to streamline workflow, support documentation, capture and interpret data, enable patient care planning, track and report outcomes, and automate claims preparation.
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This can further support patient outcomes and generate additional reimbursement.
Manage conditions with SMART goals, care plans, and evidence-based assessments.
Patients can use digital devices to capture health data for more informed care.
Providers can help address behavioral health as part of overall care for chronic illness.
