Medicare’s Annual Wellness Visits (Part 3 of 3): Additional Services that can be Billed with AWV’s

By: Christine Smidt, BA, CPC, CRC, Risk Adjustment & Quality Specialist, CHPA

Listed below are five screening tools that can be performed in the office and billed with Annual Wellness Visits (AWVs). For additional details and more screening opportunities, please visit the CMS Medicare Preventative Services Quick Reference Chart.

As with any of these HCPCS/CPT codes, you need to document the screening process and document the time (if indicated).

1. Alcohol Misuse Screening & Counseling
   • HCPCS
     • G0442 — Annual alcohol misuse screening, 15 minutes
     • G0443 — Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
   • Medicare Covers
     • Patients with Medicare Part B who:
       • Screen positive (misuse alcohol but levels or alcohol consumption patterns don’t meet alcohol dependence criteria)
       • Are competent and alert when counseling is delivered
     • Get qualified primary care physician or other primary care practitioner counseling in a primary care setting
   • Frequency
     • Annually (G0442 screening)
     • If they screen positive for misuse, 4 times per year (G0443 counseling)
2. Depression Screening
   • HCPCS
     • G0444 — Annual depression screening, 15 minutes
   • Frequency
     • Annually
3. Diabetes Screening
   • HCPCS & CPT Codes
     • 82947 — Glucose; quantitative, blood (except reagent strip)
     • 82950 — Glucose; post glucose dose (includes glucose)
     • 82951 — Glucose; tolerance test (GTT), 3 specimens (includes glucose)
   • ICD-10 Codes
     •  Z13.1
     • Note: Additional ICD-10 codes may apply. Find individual Change Requests (CRs) and specific ICD-10-CM service codes that we cover on the CMS ICD-10 webpage. Find your MAC’s website for more information.
   • Medicare Covers
     • Patients with Medicare Part B with certain diabetes risk factors or diagnosed with pre-diabetes
     • Note:Patients previously diagnosed with diabetes aren’t eligible for this benefit.
   • Frequency
     • 1 screening every 6 months for patients diagnosed with pre-diabetes
     • 1 screening every 12 months if previously tested but not diagnosed with pre-diabetes or if never tested
4. Cardiovascular Disease Screening Tests
   • HCPCS & CPT Codes
     • 80061 — Lipid panel: this panel must include:
     • 82465 —  Cholesterol, serum, total
     • 83718 —  Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
     • 84478 —  Triglycerides
   • ICD-10 Codes
     • Z13.6
     • Note: Additional ICD-10 codes may apply. Find individual Change Requests (CRs) and specific ICD-10-CM service codes that we cover on the CMS ICD-10 webpage. Find your MAC’s website for more information.
   • Frequency
     • Once every 5 years
     • Note: You can order this lab more frequently if patient has a diagnostic reason such as hyperlipidemia or diabetes, however it will no longer be considered a screening and fall into the diagnostic portion of their benefits, thus be incur coinsurance and/or deductible charges.
5. Cervical Cancer Screening with Human Papillomavirus (HPV) Tests
   • ICD-10 Codes
     • Z11.51 and either Z01.411 or Z01.419
     • Note: Additional ICD-10 codes may apply. Find individual Change Requests (CRs) and specific ICD-10-CM service codes that we cover on the CMS ICD-10 webpage. Find your MAC’s website for more information.
   • Medicare Covers
     • Asymptomatic Medicare Part B female patients aged 30–65 years. Nationally Covered Indications Effective for services performed on or after July 9, 2015, CMS has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test.
   • Frequency
     • Once every 5 years
     • Note: You can order this lab more frequently if patient has a diagnostic reason such as a history of abnormal PAP’s, however it will no longer be considered a screening and fall into the diagnostic portion of their benefits, thus be incur coinsurance and/or deductible charges.

Sources:

1. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
2. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html