The Medicare Annual Wellness Visit (AWV) allows providers to acquire critical information about patients’ health through a review of vitals, environmental risks, and medical and family history. These visits prioritize patient-provider relationship building and preventative care.
The provider can then use the collected information to identify risk factors, suggest appropriate preventive services, and create a personalized prevention plan for the patient.
These visits are comprised of three parts:
Health Risk Assessment (HRA): The first part of an AWV requires patients to complete a self-administered questionnaire that addresses all facets of their health and well-being. For this to be considered compliant, patients must self-report information on the following areas:
The risk-assessment questionnaire should include questions regarding advance care planning. Once the provider reviews the patient’s responses, the provider can identify risk factors, such as cognitive impairment, and create a personalized prevention plan to follow.
Vitals: The second component is collecting and documenting vitals. These measurements include height, weight, and blood pressure, which are essential to analyze when discussing risk factors related to cardiovascular disease, stroke, and hypertension. Height and weight are used to calculate and report on body mass index (BMI). A physical exam is not a part of an AWV routinely.
Consultation: The third component of an AWV consists of translating the HRA results into a care plan. Based on the answers to the questionnaire, providers can identify risk factors and discuss a preventative plan of action for a healthier future.
AWV Billing
Key things to note:
Effective in 2024, a new Place-of-Service (10) was created to state where the telehealth visit occurred.
Since the G0438 (AWV, Initial) and G0439 (AWV, subsequent) is payable as a telehealth visit and because a new POS was created, we recommend providers update their billing software to include the following:
Please note: If you bill the service G0438/G0439 with modifier 95/93 in POS 02, the claim will deny due to modifier and HCPCS mismatch.
On behalf of the Risk Adjustment Team at HealthTeam Advantage, please be sure to document the service as an audio only when it occurred and to use modifier 93 when applicable. Risk adjustment services must always be face-to-face, and we need to know what services were not face-to-face.
Here is CMS documentation for the AWV.