Fee Schedule Establishes Coverage for Annual Wellness Visits for Medicare Patients

Fee Schedule Establishes Coverage for Annual Wellness Visits for Medicare Patients

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

Fee Schedule, HCPCS codes

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.

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