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Printed Date: 9/22/2015
The HCPCS codes for the first Annual Wellness Visit (AWV) service (HCPCS code G0438) and subsequent AWV services (HCPCS code G0439) do not include other preventive services that are paid separately by Medicare. Such services can be provided on the same day as the AWV, but they should be identified separately using the appropriate HCPCS/CPT codes. When practitioners perform preventive services in addition to an AWV visit, billing and payment edits will continue to apply for the additional services.
If the need arises to perform a significant, separately identifiable, medically necessary evaluation and management (E/M) service in addition to the AWV, CPT codes 99201-99215 may be reported with CPT modifier 25, depending on the clinical appropriateness of the circumstances. Some of the components of a medically necessary E/M service (e.g., a portion of history or physical examination) may have been part of the AWV and should not be included when determining the most appropriate E/M level of service to bill. These services must be medically necessary to treat an illness or injury or to improve the functioning of a malformed body member.
Please see the information in the CMS IOM Publication 100-04, Chapter 12 (PDF, 1.05 MB), Section 220.127.116.11 and 30.6.2 to determine specific billing instructions.
CMS MLN Resource: CMS MLN Booklet - Annual Wellness Visit
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Last Updated: 09/01/2020