By: Christine Smidt, BA, CPC (CHPA)
The Medicare wellness visit is an annually covered visit that allows you and your patient to dedicate time to review their medical and social health history and assess preventive services that are due. During this visit, you will go over the patient’s health risks, prevention and screenings only – giving you the time needed to make sure all your patient’s immunizations, cancer screenings and personal screenings based on risk are discussed and followed up on. Also, the visit gives you the opportunity to ask questions and get in-depth information. The Medicare wellness visit is not a comprehensive physical exam; therefore a head-to-toe examination is not performed. These visits promote good health through disease prevention and detection.
There are three type of wellness visits:
- Initial Preventive Physical Exam (IPPE) – made within 12 months of your Medicare enrollment (CPT G0402)
- Initial Annual Wellness Visit – if you’ve never had an IPPE and you’ve had Medicare coverage for more than 12 months (CPT G0438)
- Subsequent Annual Wellness Visit(s) (AWV) – these take place 11 full calendar months since the last annual wellness visit (CPT G0439)
The IPPE, known as the “Welcome to Medicare” preventive visit, pays once per lifetime. We recommend looking at the patient’s Medicare card which has their Part B effective date listed. Then you will want to review the patient’s chart to determine if an IPPE/AWV has been provided. Lastly, check to be sure that it has been a year since the last IPPE/AWV has been completed.
Because you are a Federally Qualified Health Center or FQHC, your office is also able to bill G0468. This add-on code is for FQHC’s and only for Initial Preventive Physical Exam (IPPE) or an Annual Wellness Visits (AWV) and includes the typical bundling of services that would be furnished per diem to a Medicare beneficiary including all services that would otherwise be billed as a FQHC visit under G0466 or G0467.
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