Network Bulletin - An important message to health care professionals and facilities
In this Issue Volume 42, March 2011

Medicare

Articles:


Annual Wellness Visit Coding Procedures for Medicare

Medicare Part B covers two of wellness exams: the Initial Preventive Physical Exam (IPPE) or the "Welcome to Medicare Visit" and the Personalized Prevention Plan Services (PPPS), also known as the "Annual Wellness Visit". Under Medicare, the IPPE is covered within the first 12 months of coverage and the PPPS is covered annually thereafter, both for a $0 copayment.

All SecureHorizons, UnitedHealthcare and Evercare Medicare Advantage (HMO/PPO/POS/PFFS) plans also cover these wellness exams for a $0 copayment.

Accepted Codes1
Procedure Code Diagnosis Code Procedure Description

REVISED

99385-99387

V70.0
Initial comprehensive preventive medicine evaluation and management (E/M) of an individual

99395-99397

Periodic comprehensive preventive medicine reevaluation and management of an individual

G0402

Any appropriate code accepted IPPE

G0438

PPPS, first visit

G0439

PPPS, subsequent visit

1 Codes subject to change. Please review cms.hhs.gov for the full code-set.

Medicare covers an Abdominal Aortic Aneurysm (AAA) Screening for at-risk beneficiaries and an Electrocardiogram (EKG) Screening for a $0 copayment, once per lifetime.

Tips for Billing
  • Other services billed with the wellness visit that are normally subject to cost-sharing will still have that cost-sharing.
  • Clinical laboratory tests or other diagnostic services performed at the wellness visit may be subject to applicable cost-sharing.
  • Other preventive screenings and services may be provided and billed separately.
  • When performing a separately identifiable medically necessary E/M service in addition to the IPPE, CPT codes 99201-99215 reported with modifier 25 may also be billed, subject to the applicable office visit copayment.

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