Medicare Advantage patients would need to check their plan benefits to find out if they have coverage for both. However, some Medicare Advantage plans cover both Medicare AWVs (G codes) and non-Medicare (commercial) preventive visits (9938X and 9939X). Q - Can a Medicare patient receive a preventive visit?Ī - Yes, but traditional Medicare does not cover these visits (9938X and 9939X are statutorily prohibited), so patients with that coverage will have to pay 100% out-of-pocket. They are also include no co-pay or deductible. Preventive visits (9938X and 9939X) are covered by commercial/managed care and Medicaid plans and require a comprehensive physical exam. These visits do not require a comprehensive physical exam. They are the IPPE (the “Welcome to Medicare” visit, G0402), the initial AWV (G0438), and the subsequent AWV (G0439). Q - What is the difference between a Medicare AWV and a preventive visit?Ī - Medicare AWVs consist of three specific visit types statutorily covered by Medicare with no co-pay or deductible. Here are some frequently asked questions to help you further navigate the world of AWV billing, as well as a side-by-side comparison of the three types of Medicare wellness visits. The IPPE also has a slightly different set of required components (e.g., advance care planning and visual acuity screening with documentation of results in the note) than the two types of AWVs (e.g., instrumental activity of daily living and assessment of cognitive function). If the primary diagnosis code is problem-oriented (e.g., diabetes or hypertension), Medicare will most likely deny a claim for an AWV, because AWVs are “well visits.” Instead, list a well code (e.g., Z00.0X, “encounter for general adult exam”) as the primary diagnosis. They must have Part B coverage as well.ģ. Billing for a Medicare AWV when the patient only has Medicare Part A. This situation instead calls for billing G0402 (IPPE).Ģ. Billing a G0438 (initial Medicare AWV) or G0439 (subsequent Medicare AWV) when the patient has been enrolled in Medicare Part B for 12 months or less. Identifying whether to code for an Initial Preventive Physical Exam (IPPE, or the “Welcome to Medicare” visit), an initial Medicare AWV, or a subsequent Medicare AWV can be tricky.Ĭommon reasons for denial include the folllowing:ġ. If you’re seeing a high number of denials for Medicare annual wellness visits (AWVs), you’re not alone.
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