After the first 12 months of coverage, during which time the patient qualifies for an initial preventative physical examination (IPPE), Medicare will pay for an AWV including PPPS. To qualify for coverage, the patient cannot have received an IPPE or AWV within the past 12 months. Medicare coinsurance and Part B deductibles do not apply.
Physicians should report the first AWV including PPPS with HCPCS Level II code G0438 Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit and subsequent AWVs including PPPS with G0439 Annual wellness visit; includes a personalized prevention plan of service (PPPS); subsequent visit.
The first AWV is a one-time allowed Medicare benefit which includes several key elements, such as establishing the patient’s medical and family history, review of systems, etc. (For a complete list of services, and for an explanation of who may perform an IPPE and AWV, refer to CMS Pub. 100-04 Medicare Claims Processing Manual, chapter 12, sections 18.104.22.168 and 100.1.1, and chapter 18, section 140.)
Significant, separately identifiable evaluation and management (E/M) services may be reported in addition to the AWV using CPT® codes 99201-99215. Append modifier 25 to the E/M service code.