What Are the 2022 CPT Codes for Annual Wellness Visits?
What Are the 2022 CPT Codes for Annual Wellness Visits? Blog Feature

By: Alec Berry on January 12th, 2022

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What Are the 2022 CPT Codes for Annual Wellness Visits?

Annual Wellness Visit

Medical reimbursements are tied to Current Procedural Terminology (CPT) codes. They categorize and specify billing rates and rules for procedures, treatments, and care services. 

If you’re a medical care provider, you likely know this. But do you know the rates and workflows for Medicare’s wellness programs? Like, Annual Wellness Visits (AWV)? 

Knowing the billing codes for AWVs will give you a better idea of what’s expected, both by the patient and Medicare. 

Understanding billing codes will also help you project revenues and optimize your staff’s capacity. Without this information, you risk disorganization and a clouded outlook. 

At ThoroughCare, we’ve worked with more than 550 healthcare organizations, from hospital systems to accountable care organizations (ACOs), to streamline Medicare reimbursements. 

Our software assists with rules and regulations for AWVs, and it tracks all activities related to providing the program, such as conducting patient assessments, making it easier to bill for. 

In this article, we’ll briefly review the requirements of AWVs, as well as the program’s CPT codes. We’ll also provide an example return-on-investment (ROI) of an effective program. 

With this information, you’ll better understand annual wellness billing expectations and standards. You’ll also see how care management software can simplify the program.  

How Do Annual Wellness Visits Work?

As the name suggests, an AWV is a yearly assessment of one’s current health. It is entirely FREE for anyone covered by Medicare Part B. 

A doctor uses the time to discuss health history, identify potential issues and answer an individual’s questions. The overall goal is to establish a record of a person’s physical and mental well-being for the purpose of preventive health planning. 

An AWV should not be confused with a routine physical examination. The AWV is more about recognizing possible gaps in a patient’s healthcare and planning the next steps. It should include:

  • A review of your medical and family history.

  • Developing or updating a list of current providers and prescriptions.

  • Height, weight, blood pressure, and other routine measurements.

  • Detection of cognitive impairment.

  • Personalized health advice.

  • A screening schedule (or checklist) for appropriate preventive services. 

For participating, a patient will receive a personalized risk prevention plan, targeted for specific diseases or disabilities relevant to their situation. 

Wellness visits come in three varieties

There is the Initial Preventive Physical Examination (IPPE), an Initial Annual Wellness Visit (IAWV), and the Subsequent Annual Wellness Visit (SAWV). All are fairly similar, yet it’s important to understand the differences as it relates to billing. We’ll cover this more below.

How to Bill for Annual Wellness Visits

There are five items required when submitting a claim through CMS:

  1. A CPT Code for the specific type of AWV provided
  2. A ICD-10 code for a general adult medical examination
  3. Date of service
  4. Place of service
  5. Provider name

While it’s not needed, it is helpful to know the care manager assigned to a patient in case you’re ever audited: When billing, you’ll calculate the time spent with each of your patients monthly.

These are the four steps you’ll take when billing:

  1. Verify CMS requirements were met
  2. Submit claims to CMS monthly
  3. Send an invoice to patients receiving an annual visit
  4. Make sure there are no conflicting codes that have been billed

CPT Codes for Annual Wellness Visits

Below, we break down the four types of billing codes for AWVs, as well as advanced care planning.

cpt code awv chart
As mentioned above, AWVs take three forms. The program’s CPT billing codes reflect each. And while the three varieties possess specific distinctions or requirements, the key difference is when a certain AWV can be given and billed for.  

For an IPPE, your patients may only receive this benefit within the first 12 months of their Medicare enrollment. It is considered a “once in a lifetime” assessment. After the initial eligibility period, your patient cannot receive an IPPE. It is also dependent on a health risk assessment (HRA)

An IAWV is practically identical to an IPPE, except it is available to your patient after 11 months of Medicare enrollment. It is for patients that miss their window for an IPPE. An HRA drives the IAWV process, as well. But this screening also includes an optional cognitive exam and “end of life” planning. 

The Subsequent AWV is the yearly follow-up to an IAWV. Eleven months after an IAWV, a patient can attend these sessions to modify and maintain their preventive care plan, based on how their health is at any given time. 

As the years pass, and the patient’s health evolves, the doctor may use the Subsequent AWV to guide individuals toward other Medicare preventive programs, such as Chronic Care Management (CCM), Behavioral Health Integration (BHI), or Remote Patient Monitoring (RPM)

AWV for Federally Qualified Health Clinics and Advanced Care Planning

As shown above, CPT code G0468 allows federally qualified health clinics (FQHC) to bill for AWVs. This code covers all three varieties of AWVs at the same reimbursement rate. 

That said, you would still provide the type of AWV most appropriate based on your patient’s eligibility window. 

Advanced care planning (ACP) is not a type of AWV, but it can play a part in the program. 

ACP is a formal process to understand your patient’s preferences for future medical care. It is an opportunity to make a plan. And an AWV can be a chance to create it. Often, providers will complete ACP during an AWV. 

ACP is fully covered for patients under Medicare Part B, so long as it is conducted during the AWV. And it is reimbursable for your practice. It can be billed in concurrence with an AWV using CPT code 99497. 

What is the ROI of an Annual Wellness Visit Program? 

The phrase return on investment (ROI) holds a financial connotation, but a “return” isn’t entirely dependent on monetary value. General benefits are equally important, especially with regard to a person and their health.  

Your patients will benefit from AWV because it places a preventive eye on their well-being. 

The program emphasizes the creation of a personalized, patient-centered care plan by completing a health risk assessment. A care plan can cover ongoing, preventive services, as well as recommend general health management for the next five to 10 years. 

This is where a good dialogue between you and your patient is critical. An AWV and the resulting care plan can be used to direct future preventive health measures, as well as drive patient engagement.   

A wellness visit can also identify preventive health services that patients may lack awareness of, such as BHI or CCM. An AWV can be an opportunity to promote enrollment in additional care programs.

Despite the noted benefits of preventive care, only 8% of adults in the United States receive appropriate services, according to the Centers for Disease Control and Prevention (CDC)

Nearly 5% receive none.

With wellness visits, your practice can help address the broad implications of chronic disease or mental illness. These often lead to additional illnesses or health complications. 

This attention to preventive care and patient engagement can also help you sustain or improve your Merit-based Incentive Payment System (MIPS) score, which reflects reimbursement rates. 

How Can an Annual Wellness Visit Produce Revenue? 

As for AWV reimbursement rates, what is the revenue opportunity of the program?

What if 500 of your patients receive an annual Subsequent AWV, while 100 of these patients also participate in CCM every month?

cpt code awv plus ccm revenue
Offering an AWV program can generate revenue, as well as broaden care access for your patient. The combination is inherently valuable. 

Streamline Annual Wellness Visits With Software

To deliver and document wellness visits, you’ll want a system in place to manage your program.

A practical resource, such as care management software, will keep key details from being lost or overlooked. This will promote efficiency for you and your staff and help patients succeed. 

Care management software can streamline the creation of patient care plans, support staff workflows, and simplify billing. ThoroughCare’s software solution offers these exact features. 

With a clinician’s eye, we’ve designed an intuitive platform that untangles the entire AWV process, so you and your patients can capitalize on it

Our care management software enables you to offer a whole suite of wellness services that pair well with AWVs, such as CCM or BHI.

So, watch a free AWV software demonstration, and see exactly how care management software can work for your practice. 

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