1. What is an Annual Wellness Visit (AWV)?
- A Medicare reimbursable health screening to create a personal prevention plan and assess health risks
- Goals: Health promotion, disease detection, and prevention of medical conditions
- Intended to address steps prior to disease occurring, when disease becomes clinically evident, and when disease establishes maximum impact
- Purpose of the AWV: Educate, Counsel, and Refer to other services
- Not a routine head-to-toe physical examination
2. Who qualifies for an AWV?
All Medicare Part B Patients who have received Medicare Part B benefits for 12+ months and have not had their Initial Preventive Physical Exam/“Welcome to Medicare” preventive visit within 12 months.
3. How often can a patient receive an AWV?
A patient can receive an AWV once every 12 months, if:
- 12 months have passed since “Welcome to Medicare” preventive visit, or
- Review medical and family history
- Develop a list of current providers
- Measure height, weight, BMI, blood pressure and other routine measurements
4. Who can perform an AWV?
- Physician (MD or DO)
- Physician assistant (PA)
- Nurse practitioner (NP)
- Registered Nurse (RN)
- Clinical nurse specialist (CNS)
- Medical professional directly supervised by a physician (health educator, registered dietitian, nutrition professional, or other licensed practitioner)
- Assess for possible cognitive impairment—see #6 on reverse
- Identify potential risk factors for depression
- Assess functional ability and level of safety
- Establish a written screen schedule for the next 5–10 years
- Prepare list of risk factors, interventions, and treatment options (risks and benefits)
- Provide health advice and appropriate referrals for reducing risk factors• Review responses to a Health Risk Assessment
- G0439 – Subsequent AWV visit
- G0468 – Federally Qualified Health Center (FQHC) visit that includes AWV
- A diagnosis code must be reported when submitting a claim for the AWV
- Visit CMS.gov for more information on conducting AWVs
6. What is the Mini-Cog™?
- A non-invasive cognitive screening tool embedded in the AWV
- Three minutes to administer and score
- Three steps:
- Three-word registration
- Clock drawing
- Three-word recall
7. What Mini-Cog score warrants a referral to GMN?
A Mini-Cog score of less than 3 warrants a referral to a GMN Memory Assessment Clinic.
8. What’s the difference between the Initial Preventive Physical Examination (IPPE)/“Welcome to Medicare” preventive visit and the AWV?
The IPPE/“Welcome to Medicare” preventive visit is a once per lifetime benefit provided only within the first months of enrollment in Medicare Part B. The AWV is covered only after the first 12 months of Medicare Part B coverage have passed. The AWV can be provided annually once per 12-month period thereafter.
9. How is the AWV billed and coded?
- + Medicare covers an AWV for beneficiaries. No deductibles or co-payments apply for an AWV.
- Coding:
- G0402 – IPPE/“Welcome to Medicare” preventive visit
- G0438 – First AWV visit
- G0439 – Subsequent AWV visit
- G0468 – Federally Qualified Health Center (FQHC) visit that includes AWV
- A diagnosis code must be reported when submitting a claim for the AWV
10. What should I tell eligible patients about the AWV?
- Medicare pays 100% for the AWV
- The AWV focuses on health promotion and prevention
- A problem-oriented visit with a physical examination isn’t part of the AWV and is subject to deductibles or coinsurance
Sources: American Academy of Family Physicians, Alzheimer’s Association, Centers for Medicare & Medicaid Services Medicare Learning Network, Quality Insights
Sponsored by the Georgia Department of Human Services.Managed by the Goizueta Alzheimer’s Disease Research Center at Emory University.
info@GaMemoryNet.org // GaMemoryNet.org
