Medicare Advantage News:
Reminders About Important Medicare Exams and Visits

The Centers for Medicare & Medicaid Services (CMS) provides an annual wellness visit (AWV) and health risk assessment (HRA) benefit for Medicare beneficiaries, including Medicare Advantage members. Following are some important reminders for network physicians who see Medicare-eligible patients.

AWV doesn’t replace IPPE

The AWV does not replace the Initial Preventive Physical Examination (IPPE) — also known as the “Welcome to Medicare Visit” — that new beneficiaries receive within 12 months of enrolling in Medicare.

The AWV is not covered during the first 12 months of a beneficiary’s initial enrollment in Medicare.

AWV includes Health Risk Assessment

The AWV requires a Health Risk Assessment (HRA) and a customized wellness or personal prevention plan.

Medicare Advantage medical policy outlines coverage criteria for AWV

Highmark Medicare Advantage Medical Policy N-98 provides comprehensive details regarding coverage and billing guidelines for the AWV, including Personalized Prevention Plan Services.

For more information, visit cdc.gov or the Provider Resource Center . The Annual Wellness Visit Member Checklist meets CMS-required components for the HRA, and the checklist is available on the Provider Resource Center.

Use correct coding to ensure proper claims processing and reimbursement

The IPPE, AWV first visit, and AWV subsequent visit each have a distinct procedure code. To avoid claim rejections and ensure proper reimbursement, the procedure codes to use when billing are:

• G0402 — Initial Preventive Physical Exam (IPPE)
• G0438 — Annual Wellness Visit, First (AWV)
• G0439 — Annual Wellness Visit, Subsequent (AWV)

We thank you for the quality care you provide to all your Highmark patients, including our Medicare-eligible members.