Part B Insider (Multispecialty) Coding Alert

Published on Thu Jul 12, 2012 PDF

Plus: Senior Medicare Patrol program boosts its ranks.

Ever since CMS began to pay for annual wellness visits (AWVs) and Welcome-to-Medicare (WTM) exams, practices have questioned whether non-physician practitioners could bill for these services. CMS has finally included that information as part of its "Preventive Services Frequently Asked Questions" file, which the agency published on July 9.

According to the document, the following practitioners can perform an AWV: physicians (doctor of medicine or osteopathy), physician assistants, nurse practitioners, clinical nurse specialists, medical professionals (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy).

As for the WTM, also referred to as the Initial Preventive Physical Exam (IPPE), Medicare will cover the exam if one of the following staff members performs it: physician (doctor of medicine or osteopathy) or other qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical nurse specialist).

CMS stresses that the practitioners must be working within their state scopes of practice. For more on CMS's preventive care FAQs, visit www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf.