ANNUAL WELLNESS VISIT (AWV), ADVANCE CARE PLANNING (ACP), ANNUAL PHYSICAL EXAMINATION AND SCREENING ELECTROCARDIOGRAM (EKG)
COVERAGE/FREQUENCY
An annual wellness visit (AWV) is covered as a preventive service for individuals who are no longer within the 12-month period after the effective date of their first Medicare Part B coverage period, and who have not received an initial preventive physical examination (IPPE) or AWV within the past 12 months.
The initial AWV is covered as a preventive service once in a lifetime. Subsequent AWV's are covered once a calendar year.
An optional element of the annual wellness visit is voluntary advance care planning (ACP). ACP services are covered as a preventive service once a calendar year when performed in conjunction with an AWV.
In addition to the AWV, the Company also provides coverage for annual physical examinations under the member's preventive benefit.
An annual physical examination (99381-99387, 99391-99397) is covered as a preventive service once a calendar year.
In addition, a screening electrocardiogram (EKG) is covered as a preventive service when it is as a result of an annual physical examination.
Social Determinants of Health (SDOH) Risk Assessment is covered as preventive once a year when performed in conjunction with an AWV.
CPT Procedure Code Number(s) and Narrative(s) | ANNUAL PHYSICAL EXAMINATION
99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397
ADVANCE CARE PLANNING
99497, 99498
ROUTINE ELECTROCARDIOGRAM
93000, 93005, 93010 |
ICD-10 Diagnosis Code Number(s) and Narrative(s) | N/A |
HCPCS Level II Code Number(s) and Narrative(s) | G0136 Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5 to 15 minutes
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0468 Federally qualified health center (FQHC) visit, initial preventive physical exam (IPPE) or annual wellness visit (AWV) |
INITIAL PREVENTIVE PHYSICAL EXAMINATION (IPPE) AND SCREENING ELECTROCARDIOGRAM (EKG) (ALSO KNOWN AS THE "WELCOME TO MEDICARE PREVENTIVE VISIT")
COVERAGE
An Initial Preventive Physical Examination (IPPE) is covered as a preventive service for all newly enrolled Medicare Advantage members who receive the IPPE within the first 12 months after the effective date of their Medicare Part B coverage.
In addition, a screening electrocardiogram (EKG) is an optional preventive service that may be performed as a result of an IPPE.
FREQUENCY
The IPPE is covered as a preventive service once in a lifetime.
Preventive coverage for screening EKGs is provided once in a lifetime to all newly enrolled Medicare Advantage members who receive the IPPE within the first 12 months after the effective date of their Medicare Part B coverage.
CPT Procedure Code Number(s) and Narratives | N/A |
ICD-10 Diagnosis Code Number(s) and Narrative(s) | N/A |
HCPCS Level II Code Number(s) and Narrative(s) | G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0403 Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0404 Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0405 Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
G0468 Federally qualified health center (FQHC) visit, initial preventive physical exam (IPPE) or annual wellness visit (AWV) |
MISCELLANEOUS
PROLONGED PREVENTIVE SERVICES
Prolonged preventive services are covered as a preventive service in the office or other outpatient setting when billed as an add-on to an applicable preventive service.
CPT Procedure Code Number(s) and Narrative(s) | N/A |
ICD-10 Diagnosis Code Number(s) and Narrative(s) | N/A |
HCPCS Level II Code Number(s) and Narrative(s) | G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service) |