Wiki Medicare Annual Wellness Visit

[jenn13088]

My practice has never billed for the Medicare Annual Wellness Visit and one of our providers was told by another provider in our community that they bill for the annual wellness visit AND the a physical (using an E/M office code) on the same day with mod.-25.

Per the Medicare Learning Network article ICN 905706 January 2014 FAQs:
Can I bill a seperate E/M service st the same time as the AWV?
"Medicare may pay for a significant, seperately identifiable, medically necessary E/M service you bill at the same time as the AWV with modifier -25.
That portion of the visit must by medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member."

I would interpret this as "NO", only an acute visit would be billable when medically necessary. A physical would not fall into this scope. Does anyone else agree??

 

[betharndt]

I didn't think Medicare paid for physicals anyway...do they? We're about to get into the Wellness Visits in the new year.

 

[chasarmil]

You can bill an acute visit with an Annual Wellness Visit. Providers need to keep in mind that if they bill for an acute visit and the patient did not know they were going to do this, the patient could get a bill for their copay/deductible/coinsurance.