# Credentials of who can perform Wellness



## wynonna (Jul 17, 2018)

Please help:  desperate to find out answer for an MD/billing meeting.  
Can an LPN (licensed practical nurse) or RN (registered nurse) perform any part of Wellness?
For example:  For G0402--Intro to Medicare?, G0438--Initial Wellness?, or G0439--Subsequent wellness?
If yes, which areas can he/she participate in?  (gathering info re: screening tests,  history, risk factors, chief complaint, if any)
Can a RN or LPN perform any part of the physical exam?
Thank you!!


----------



## Pathos (Jul 17, 2018)

Here is an official FAQ from CMS:

_"*Who can perform an Annual Wellness Visit?*
Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a:
• Physician (doctor of medicine or osteopathic medicine)
• Physician assistant
• Nurse practitioner
• Clinical nurse specialist
• Medical professional (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 discussed in the preamble of the calendar year 2011 Physician Fee Schedule rule, CMS is *not* assigning particular tasks or restrictions for specific members of the team. We believe it is better for the supervising physician to *assign* specific tasks to *qualified* team members (*as long as they are licensed in the State and working within their state scope of practice*). This approach gives the physician and the team the flexibility needed to address the beneficiary’s particular needs on a particular day. It also empowers the physician to determine whether specific medical professionals who will be working on his or her wellness team are needed on a particular day. The physician is able to determine the coordination of various team members during the AWV."_

Additional general readings on IPPE
Additional general readings on AWV


----------



## wynonna (Jul 17, 2018)

*Clinical Nurse Specialist*

Thank you--very helpful!
For Clinical Nurse specialist, anyone familiar with which credentials/licensing this means?   For example, LPN (licensed practical nurse) or RN (Registered nurse) or can both perform Wellness?
thank you


----------



## Pathos (Jul 17, 2018)

For definitions on what a Clinical Nurse Specialist (CNS), I went with their association.

CMS also designates a CNS as:

_1. Be a registered nurse who is currently licensed to practice in the State where he or she practices and be authorized to furnish the services of a clinical nurse specialist in accordance with State law;
2. Have a master’s degree in a defined clinical area of nursing from an accredited educational institution; and
3. Be certified as a clinical nurse specialist by a recognized national certifying body that has established standards for CNSs._

CMS Medicare Benefit Manual 15.210

So in other words, a CNS would be at least an RN who has had advanced training and education above the RN level.

Whether a LPN or RN can perform any parts of the AWV/IPPE, CMS explains this is up to the individual provider. Also, remember that the IPPE/AWV is not a Complete Physical Exam, but merely hits on some of CMS desired metrics.


----------



## wynonna (Jul 17, 2018)

*Clinical Nurse Specialist*

Again, very helpful, and thank you!
"CMS explains this is up to the individual provider". so is there a reference in AMA version of CPT or section in Medicare/CMS/NGS website where I can find these very helpful details?
thank you again


----------



## Shelly7169 (Nov 2, 2018)

*Signature when RN completes Annual Wellness Visit?*

Is just the RN signature sufficient on the Annual Wellness Visit?  Or must the supervising provider countersign?


----------

