When an RN performs the Medicare annual wellness visit, is a cosign required by the physician? We've gotten contradicting information. As of 5/20/21, Palmetto GBA said a cosign is required because it falls under the incident-to provision, however all documents from CMS say the AWV is not considered an incident-to service. We've not been able to find anything that says a cosign is required in all of the research we've done. These are being performed under direct supervision of the billing provider, but not being cosigned by the billing provider. My next question then, does "direct supervision" mean a cosign is required?