Wiki AWV G0439

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KoBee

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In need of some help for accuracy on when its okay to code/bill a subsequent AWV. Would appreciate any source that gives details. Thanks

Medicare guidelines state " covered once every 12 months"




Does that mean from date to date 2/10/22 - 2/10/23

or

Does that mean 2/10/22 to 2/1/23 (any day within the 12 month) ?
 
In my experience, the contractors will deny this it if it's done even one day early, and I'm pretty sure the 2/10/22 to 2/1/23 would result in a denial as that's 9 days less than the 12-month required interval. I've always advised providers to go out at least one year and one day (if not more, just to be safe) before scheduling and performing the next annual service.
 
thomas7331 said:
In my experience, the contractors will deny this it if it's done even one day early, and I'm pretty sure the 2/10/22 to 2/1/23 would result in a denial as that's 9 days less than the 12-month required interval. I've always advised providers to go out at least one year and one day (if not more, just to be safe) before scheduling and performing the next annual service.
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I have read that there is no need to wait 12 months between visits as long as the visits are in different calendar years.

This is where the confusion comes along. Our practice has done date to date to be on the safe side. say patient had AWV til December 15, 2022, they now have to wait 12 month till December 15, 2023 for next AWV. Thats what I have always been taught and told.
 
KoBee said:
I have read that there is no need to wait 12 months between visits as long as the visits are in different calendar years.

This is where the confusion comes along. Our practice has done date to date to be on the safe side. say patient had AWV til December 15, 2022, they now have to wait 12 month till December 15, 2023 for next AWV. Thats what I have always been taught and told.
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The exact practice might vary from one MAC to another. You may wish to contact the MAC responsible for the jurisdiction where your practice is located to get a definitive answer. However, the link you posted above does specifically state that it will only be covered for a patient who has not had another wellness visit within the last 12 months:

We cover an AWV that delivers Personalized Prevention Plan Services (PPPS) for patients who:
  • Aren’t within 12 months after the patient’s first Part B benefits eligibility date
  • Didn’t get an IPPE or AWV within the past 12 months
 
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