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Wiki Medicare wellness visit
- Thread starter swiedner7
- Start date
Pathos
True Blue
Any licensed physician and most NPPs can furnish AWVs:
From CMS' MLN THE ABCs OF THE ANNUAL WELLNESS VISIT (AWV)
"Medicare Part B covers an AWV if performed by a:
● Physician (a doctor of medicine or osteopathy)
● Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
● Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team
of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)"
So, to your first question I would say your OBGYN provider should be able to perform G0438/G0439, as long as documentation supports the correct code. Also, remember that the Initial AWV can only be billed 12 months after any IPPE (Initial Physical Preventive Exam), and no other AWVs have been billed out previously by any Medicare provider (Yes, that means Part C as well). Otherwise a Subsequent AWV (G0439) is more appropriate as long as documentation still supports this code.
A regular GYN exam would most likely NOT cover the documentation requirements for an AWV.
The MLN article does a good job explaining what documentation is required to bill an AWV.
Hope this helps!
From CMS' MLN THE ABCs OF THE ANNUAL WELLNESS VISIT (AWV)
"Medicare Part B covers an AWV if performed by a:
● Physician (a doctor of medicine or osteopathy)
● Qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist)
● Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team
of medical professionals who are directly supervised by a physician (doctor of medicine or osteopathy)"
So, to your first question I would say your OBGYN provider should be able to perform G0438/G0439, as long as documentation supports the correct code. Also, remember that the Initial AWV can only be billed 12 months after any IPPE (Initial Physical Preventive Exam), and no other AWVs have been billed out previously by any Medicare provider (Yes, that means Part C as well). Otherwise a Subsequent AWV (G0439) is more appropriate as long as documentation still supports this code.
A regular GYN exam would most likely NOT cover the documentation requirements for an AWV.
The MLN article does a good job explaining what documentation is required to bill an AWV.
Hope this helps!
jhendrix08
Guest
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Agreed, yes the physician can do it BUT a regular GYN exam doesn't meet the criteria. We are a PCP office with a large amount of Medicare patients so we do Medicare Wellness exams everyday. Feel free to reach out should you have any more questions.