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Medicare covers a yearly appointment to discuss your plan of preventive care in the coming year.
This appointment is called the Annual Wellness Visit (AWV).
The Annual Wellness Visit is similar to the one-time Welcome to Medicare preventive visit but has important differences.
For example, like the Welcome to Medicare visit, the Annual Wellness Visit (Initial Preventative Physical Examination) is not a head-to-toe physical.
However, you cannot receive your Annual Wellness Visit within the first year you are enrolled in Medicare or within the same year you have your Welcome to Medicare exam.
G0438 - Initial AWW - includes a personalized prevention plan of service (PPPS)
G0439 - Subsequent AWV - updates a personalized prevention plan of service (PPPS)
Components Initial AWV
Components Subsequent AWV
Opportunities for additional preventative services
Provider can bill for G0506 in addition to the AWV/IPPE billing
Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services and MAY BE ADDED TO AN AWV- but must be seen by a QHCP).
The G0506 code is particularly appropriate when the CCM initiating visit is a less complex visit (such as a level 2 or 3 E/M visit). G0506 can be billed along with higher level E&M visits if the practitioner’s effort and time exceeded the usual effort described in the initial visit E&M code. G0506 can also be billed when the initiating E&M visit addresses problems unrelated to Chronic Care Management and the CCM related work is not included in the initial visit code.
Could be face-to-face and/or non-face-to-face, but the time spent doing the CCM care planning must not already be reflected in the CCM initiating visit itself or in the time spent during the monthly CCM (i.e., in CPT 99490, CPT 99487, CPT 99489)
G0506 is meant to be billed only once per beneficiary during the initiation of the patient into Chronic Care Management.
What services are you implementing in 2019?
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ABOUT THE AUTHOR:
Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website.
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