Provide Your Patients the Best AWV
By Karrie May, CPC
Many patients and their providers misinterpret Medicare annual wellness visits (AWV). You need to know the types of AWV to assure your practice runs smoothly.
The AWV is a visit allowing the physician to get an overview of the patient’s current health status. These screenings take the form of one of three types of visits, depending on patient status and services previously received:
1. The Initial Preventive Physical Exam (IPPE), or “Welcome to Medicare” Visit: A patient may receive this once-in-a-lifetime benefit within the first 12 months of Medicare eligibility. The visit (reported to Medicare with HCPCS Level II code G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment) must include the following components:
- Height, weight, blood pressure (BP), and visual acuity
- Review of medical and social history
- Review of potential risk factors for depression, functional ability (including hearing), and level of safety (specifically including risk of falling and other at-home risks, and the ability to perform daily living activities), with the goal of health promotion and disease detection
- Education, counseling, and referral with respect to screening and preventive services currently covered by Medicare Part B
- Covered immunizations (review and future plan)
- Body mass index (BMI)
- End-of-life planning upon an individual’s consent
2. The Initial Annual Wellness Visit (AWV): The AWV may be performed at any point in the beneficiary’s life, but only once. After the patient receives an IPPE (G0402), at least 11 full months must pass before he or she receives the initial AWV. The initial AWV (reported to Medicare with HCPCS Level II code G0438 Annual wellness visit, including a personalized prevention plan of service (PPPS), first visit) includes the following services:
- Establish or update the individual’s medical and family history
- Depression screening
- List the individual’s current medical providers, suppliers, and all prescribed medications
- Record vitals to include height, weight, BMI, BP, and other routine measurements
- Assess functional ability, to include hearing or sensory loss and home safety
3. The Subsequent Annual Wellness Visit: This service may be performed every year, as long as 11 full months have passed since the previous (initial or subsequent) AWV. The service (reported with G0439 Annual wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit) includes:
- An update of the individual’s medical/family history
- An update of the list of current providers
- Measurement of an individual’s height, weight, BMI, BP, and other routine measurements
- Detection of any cognitive impairment
CMS requires that patients receiving any of the above services complete a Health Risk Assessment (HRA) form. The HRA determines the patient’s health behaviors and risk factors. There are 34 required elements. General rules for the HRA include:
- The form must be written at a sixth grade literacy level, and it must be able to be completed in 20 minutes or less.
- The HRA can be accessed via Internet or phone, or may be paper-based, accessible to all patients in a language familiar to them.
- The HRA may be completed by the patient or the caregiver, but must be completed before the face-to-face encounter with the physician. If the HRA is filled out in the physician’s office, office staff may help patients complete the form.
Learn more: You can find a summary of the requirements of all Medicare Wellness Visits on the CMS website.