Annual Wellness Visit Codes

Healthcare professionals who have automated workflow for Medical Billing with Built-In Scheduling systems always remind their patients not to miss the annual wellness visits. The reason is that it’s covered fully 100% without processing towards the member’s “out-of-pocket maximum,” such as deductible, copay, or co-insurance and on the patient end it’s good to have an annual wellness visit once a year to make sure a healthy life. Insurance companies also encourage patients to take advantage of this opportunity to improve their overall health. To avoid medical billing denial on the Annual Wellness visit and get the full 100% reimbursement, it’s essential to bill the correct code in Medical Billing Software and keep track of the annual maximum limits and other factors. The Medical Billing Companies mainly keep track of such denials to resolve issues and improve RCM workflow at healthcare practices.

Insurance companies also appreciate their members receiving an annual wellness visit and a physical exam each calendar year. Here are brief details about the applicable codes based on age and intervals between the services.

Wellness Visits
CPT G0402 – The Initial Preventative Physical Examination with EKG (IPPE) is offered once in a lifetime and must occur within the first 12 months of Medicare eligibility. This is the “Welcome to Medicare” visit that consists primarily of discussion and personalized prevention planning.

CPT G0438 – The Initial Annual Wellness Visit with Health Risk Assessment (Initial AWV w/ HRA) is offered once in a lifetime and must occur after the first 12 months of Medicare eligibility and if the member did not receive an IPPE (G0402). This is very similar to the “Welcome to Medicare” visit, as it consists primarily of discussion and personalized prevention planning.

CPT G0439 – The Subsequent Annual Wellness Visit with Health Risk Assessment (Subsequent AWV w/ HRA) is offered once per year and must occur after the first 12 months of eligibility and 11 months after receiving, and IPPE (G0402) or Initial AWV (G0438).

Physical Exam CPT Codes and Descriptions
CPT 993XX – The preventative visit with the physical exam is offered once per year as an added benefit through WellCare. (Preventative visit code selection is age-driven).

If you are a member and would like to know more about your coverage guidelines, please reach out to your insurance member services line and check your benefits and coverage details. If you need outsourced medical billing services Contact iCareBilling for a Practice Management consultation today.