Annual Wellness Visit - Fee for ServiceCreating a personalized PREVENTION and treatment plan is an essential yet often overlooked health service. The Centers for Medicare and Medicaid Services (CMS) has acknowledged this care gap and has created a series of wellness benefits that emphasize the importance of providing these services annually for every patient. Caravan Health believes these are an optimal opportunity to engage with patients to improve patient experience, outcomes and cost of care.

Utilize Lightbeam, EHR, client portal or MAC to identify patients eligible for Annual Wellness Visit or IPPE.

Call identified patients to explain need and reason for visit.

Explain services, team roles, purpose and benefits of visit prior to proceeding with services.

Verify past medical & family history, all current prescribed and OTC medications, Vaccination & Prevention status, treating providers.

Review appropriate coding and identify any HCC gaps that need to be addressed by provider.

Take time to review and document all ACO and organizational quality metrics in the appropriate location within EHR.

Confirm patient’s readiness for ACP and discuss the patient’s wishes and preferences for medical treatment.

Provider closes visit and/or proceeds to appropriate E&M visit- reviews and interprets screenings, PMHx, HCC, Meds, prevention, & orders necessary services.

Determine need for Chronic Care Management or other care coordination services.

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Discuss and perform additional health risk screenings- PHQ-9, Mini-Cog, Timed Up-and-Go, tobacco and other applicable SBIRT screenings.

W O R K F L O W

PatientEligibility

ReachOut

Engage

Verify MedicalHistory

Note ComplexityCoding

Tick theBox

Initiate AdvanceCare Planning (ACP)

OverseeingProvider Visit

Need for OngoingCare Coordination

EvaluateAdditional Risks

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What is an Annual Wellness Visit? Coding, Billing &Reimbursement Specifics

Who Can Perform the AnnualWellness Visit?

Medicare covers two separate types of preventive visits. Both services provide a valuable opportunity to establish the foundation for team-based primary care.

Initial Preventive Physical Exam (IPPE)• An introductory visit for new Medicare patients that

can only be provided within the first 12 months thepatient receives Part B benefits.

• Includes a physical exam

Annual Wellness Visits (AWV)• An annual benefit for Medicare patients covered under

Part B.• This visit is covered once every 12 months who have

not gotten either an IPPE or an AWV within the past 12months.

• Medicare pays for the Initial AWV once per lifetime andpays for one Subsequent AWV per year thereaftervisits). An IPPE is not required for an Annual WellnessVisit.

• Does not include a physician exam

Initial Preventive Physical Examination (IPPE):• Use HCPCS code G0402.• You must provide all components of the IPPE prior to

submitting a claim for the service.• NOTE: A screening EKG can be administered during this

visit and reported with HCPCS codes G0403, G0404, orG0405.

Annual Wellness Visit (AWV):• Use HCPCS codes G0438 (AWV, Initial) and G0439 (AWV,

Subsequent).• Report all pertinent active diagnosis code from the

beneficiary’s health history that has been reviewedwhen submitting a claim for the AWV.

Separate same day E/M Services:• When you furnish a significant, separately identifiable,

medically necessary Evaluation and Management (E/M)service along with the AWV, Medicare may pay for theadditional service.

• Report the additional CPT code with modifier-25.• That portion of the visit must be medically necessary to

treat the beneficiary’s illness, injury, or to improvefunction/status.

Advance Care Planning (ACP):• You can provide ACP at the time of the AWV, at the

beneficiary’s discretion.• ACP is reported with CPT® codes 99497 (first 30

minutes) and 99498 (each additional 30 minutes).• You must report a diagnosis code that is consistent

with a beneficiary’s exam when submitting a claim forACP.

• Medicare waives (once per year) both the coinsuranceand the Medicare Part B deductible for ACP when it is:

1) Provided on the same day and by the sameprovider as the covered AWV

2) Billed with modifier -33 (Preventive Service), or3) Billed on the same claim as the AWV.

Annual Wellness Visit Components– Initial AWV and IPPE

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Initial Preventive Physical Exam(IPPE):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nursespecialist)

Annual Wellness Visit (AWV):• Physician (MD, DO);• Qualified non-physician practitioner (a physician

assistant, nurse practitioner, or certified clinical nursespecialist); or

• Medical professional (including a health educator,registered dietitian, nutrition professional, or otherlicensed practitioner); or a team of such medicalprofessionals who are working under the directsupervision of a physician

Talk with your Caravan Health Improvement Manager, Clinical Leader or visit the Medicare Learning Network for more information1. Perform a Health Risk Assessment (AWV only)

2. Assess Cognitive Function (AWV only)3. Establish a list of current providers and suppliers (AWV only)4. Complete review of beneficiary & medical history5. Measure height, weight, blood pressure, BMI and (pertinent physical & visual acuity for IPPE only)6. Review the beneficiary & potential risk for factors for depression, including current or past history

of depression or other mood disorders with appropriate screening tool7. Review the beneficiary & functional ability and level of safety (ADLs, Fall Risk, Hearing Impairment, Home Safety)8. Establish an appropriate written screening schedule for the beneficiary such as a checklist for the next 5-10 years9. Establish a list of beneficiary risk factors and condition for which primary,

secondary, or tertiary interventions are recommended or underway10. Provide the beneficiary with personalized health advice providing appropriate

referrals for health education, counseling or other necessary services11. Furnish, at the beneficiary’s discretion, advance care planning services (ACP)

AWV-023-20190520-APP | Proprietary & Confidential, Do Not Distribute