Wiki Medicare AWV exams with an additional OV charge

[dsmoon]

does the Medicare Annual Wellness visit include the provider discussing and treating a patient's chronic conditions (including refilling meds) or can you bill a separate E/M without the condition being a new problem or exacerbated?
Our providers are being told that if they refill patient meds at the time of the AWV visit then they can bill an additional office visit charge. Any help or advise as to how your clinic approaches these would be appreciated

 

[ReneeGillam CPMA CMOM CMC]

Found this on: https://www.cms.gov/newsroom/fact-s...25-medicare-physician-fee-schedule-final-rule
Office/Outpatient (O/O) Evaluation and Management (E/M) Visits

For CY 2025, we are finalizing our proposal to allow payment of the O/O E/M visit complexity add-on code, Healthcare Common Procedure Coding System (HCPCS) code G2211, when the O/O E/M base code — Current Procedural Terminology (CPT) codes 99202-99205, 99211-99215 — is reported by the same practitioner on the same day as an annual wellness visit (AWV), vaccine administration, or any Medicare Part B preventive service, including the Initial Preventive Physical Examination (IPPE), furnished in the office or outpatient setting.

 

[HannahKnight90]

What if the codes billed are only 99214 and G2211, per the 2024 guidelines, we could bill the codes and got payment. Per 2025 guidelines, we are getting denials for bundling. How should we handle these denials?

 

[csperoni]

What if the codes billed are only 99214 and G2211, per the 2024 guidelines, we could bill the codes and got payment. Per 2025 guidelines, we are getting denials for bundling. How should we handle these denials?

So the only CPT are 99214 and G2211? If so, the guidelines for 2024 and 2025 are the same. Medicare would not bundle those. The policy of commercial payors could differ.