Contractors Holding AWV Claims Until April 4

If you’re wondering why your annual wellness visit (AWV) claims aren’t being paid, there’s a good reason. The Centers for Medicare & Medicaid Services (CMS) has instructed all Medicare contractors to hold all AWV claims submitted on types of bill 12X and 13X with dates of service on and after Jan. 1 through April 3.

Current editing prevents the billing of G0438 Annual wellness visit, including PPPS, first visit and G0439 Annual wellness visit, including PPPS, subsequent visit if they are the only services on the claim. Claims containing the AWV along with other services are processing but the AWV service is not being paid.

CMS says the Medicare contractors’ systems will be ready to process claims containing codes G0438 and G0439 submitted on TOBs 12X and 13X no later than April 4, which is the official implementation date.

The Patient Protection and Affordable Care Act (PPACA) allows for payment under the Medicare Physician Fee Schedule (MPFS) for AWVs including personal prevention plan services (PPPS), effective Jan. 1, 2011. Medicare coinsurance and Part B deductibles do not apply. Definitions relative to the AWV are included at Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, section 280.5.

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2 Responses to “Contractors Holding AWV Claims Until April 4”

  1. Pam says:

    Does anyone knows if theres a particular icd code to be used for this wellness visits?

  2. John A., CPC Illinois says:

    Hello Pam,

    It’s still typically v70.0. The MAC’s edits were denying them because the effective date is not until April 4th!

    Thanks

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