MEDICARE PREVENTIVE SERVICES

Hello all please find below article for medicare billing and coding relating information.

Resources

·         General Medicare Preventive Services Resources

·         CMS Webpage

Annual Wellness Visit (AWV)

HCPCS/CPT Codes

G0438 – 

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

G0439 – 

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

99497 – 

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other 

qualified health care professional; first 30 minutes, face-to-face with the patient, 

family member(s), and/or surrogate

99498 – 

Advance care planning including the explanation and discussion of advance directives 

such as standard forms (with completion of such forms, when performed), by the physician 

or other qualified health care professional; each additional 30 minutes 

(List separately in addition to code for primary procedure)

ICD-10 Codes

See the CMS ICD-10 webpage for individual CRs and coding translations for ICD-10, and

 contact your MAC for guidance

Who Is Covered

All Medicare beneficiaries who:

·         Are not within 12 months after the effective date of their first Medicare Part B coverage and

·         Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the 

      past 12 months

Frequency

·         Once in a lifetime for G0438 (first AWV)

·         Annually for G0439 (subsequent AWV)

·         Annually for optional 99497, 99498

Medicare Beneficiary Pays

G0438 and G0439:

·         Copayment/coinsurance waived

·         Deductible waived

99497 and 99498:

Copayment/coinsurance and deductible waived for Advance Care Planning when furnished as an optional element of an AWV

Other Notes

For services furnished on or after January 1, 2016, Advance Care Planning is treated 
as an optional preventive service when furnished with an AWV.
Practitioners may provide Advance Care Planning outside of the AWV multiple times in a year, but the practitioner must document a change in the beneficiary’s health for each additional service in a year. When providing Advance Care Planning outside the AWV, the beneficiary is responsible for the deductible and coinsurance.The deductible and coinsurance for Advance Care Planning is only waived when furnished as an optional element of an AWV, which requires:Billing with modifier –33 https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html(Preventive Service) on the same claim as an AWVFurnishing on the same day and by the same provider as the AWV
Refer to The ABCs of the Annual Wellness Visit for more information.

Note:-  For Additional information please go through below.

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html