Wellness Visit Omissions Clarified

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  • July 1, 2011
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Following the omission of important information in its manual, the Centers for Medicare & Medicaid Services (CMS) clarified in Transmittal 2247, June 24, the policies concerning late night admissions and the mix of residents under the primary care exception. The policies regarding the interpretation of diagnostic radiology and other tests are included, as are the policies regarding the use of modifiers GC Teaching physician and GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
CMS failed to include the information when Affordable Care Act coverage of annual wellness visits (G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit, and G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit)  policies were detailed. The policies became effective Jan. 1. The additions amend the Medicare Claims Processing Manual, Pub. 100-04, sections 100.1.1 Evaluation and Management (E/M) Services, 100.1.2 Surgical Procedures, and 100.1.8 Physician Billing in the Teaching Setting.
The edits are detailed in Transmittal 2247.

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