Who Is Covered

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized prevention plan based on your current health and risk factors. This includes:

   • Health risk assessment (your doctor or health professional will ask you to answer some questions before or during your visit, which is called a health risk assessment. your responses to the questions will help you and your health professional get the most from your yearly “wellness” visit.)

   • Review of medical and family history.

   • Develop or update a list of current providers and prescriptions.

   • Height, weight, blood pressure, and other routine measurements.

   • Detection of any cognitive impairment.

   • Personalized health advice.

   • A list of risk factors and treatment options for you.

   • A screening schedule (like a checklist) for appropriate preventive services.

HCPCS/CPT Codes

G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit

G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit

G0468 - Federally qualified health center (FQHC) visit, IPPE or AWV; FQHC fqhc visit that includes an initial preventive physical examination (IPPE) or annual wellness visit (AWV) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV

99497 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

99498 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

ICD-10-CM Codes

No specific diagnosis code.

See the CMS ICD-10 webpage for individual Change Requests (CRs) and coding translations for ICD-10 and contact your Medicare Administrative Contractor (MAC) for guidance.

Frequency

G0438 - Once in a lifetime for G0438 (first AWV); or

G0439, G0468 - Annually (subsequent AWV) and G0468 (AWV in FQHC)

99497, 99498 - Annually for optional 99497, 99498

Medicare Beneficiary Pays

G0438 and G0439:

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

G0468:

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

   Note: AWV or IPPE must be provided with a standard bundle of services available to all beneficiaries; for more information about billing for this service, refer to Medicare Claims Processing Manual, Chapter 9, Section 60.2

99497 and 99498:

   Note: Copayment/coinsurance and deductible waived for Advance Care Planning when furnished as an optional element of an AWV

References