Fee Schedule Establishes Coverage For Annual Wellness Visits For Medicare Patients

The new Fee Schedule incorporates several provisions of the Affordable Care Act of 2010 that was passed in March

.

New coverage: The Fee Schedule establishes coverage for annual wellness visits for Medicare patients.

The rule that was issued on November 3 is a key step toward improving the health status of Medicare beneficiaries by providing coverage for annual wellness visit that'll allow a physician and patient to develop closer ties to improve the patient's long term health.

Change: If your doctor carries out a procedure that meets CMS's description of an annual wellness visit, don't report a code from CPT's preventive medicine section to your Part B carrier, the Final Rule indicates. CMS doesn't pay for preventive medicine services billed under 99381-99397. Instead, report one of the following newly-established HCPCS codes that'll be effective from January 1, 2011:

G0438 -- Annual wellness visit; includes a personalized prevention plan of service, first visit

G0439 -- Annual wellness visit; includes a personalized prevention plan of service, subsequent visit

CMS has assigned 2.43 physician work RVUs to G0438 and 1.50 work RVUs to G0439. Beneficiaries who have been enrolled in Part B for 12 months will be eligible for an initial preventive physical exam (also known as an IPPE, which is billed with G0402). After the 12 months of Part B coverage on or after January 1, 2011 beneficiaries would be eligible for an annual wellness visit as described by the new G codes, assuming that patient has not had an IPPE within the preceding 12-month period, states the Fee Schedule.

by: James Article

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