Medicare Wellness Visits: One Visit a Year… But 3 Codes?

Thanks to the Affordable Care Act, Medicare is (finally) covering yearly preventative, or “wellness,” visits for patients; however, the annual visit is actually separated into three different encounters.   Although each visit is largely similar, there are a few minor details separating each visit, and, as you know, these minor details must be followed as it is the difference between reimbursement 🙂 and denial 🙁

The most prevalent difference between the 3 encounters, and the one that likely leads to the most denials, is the timing of the visit.  Below are the 3 visits, including appropriate g-codes, along with details regarding their respective timings:

Code

Name

Timing

G0402 Introduction to Medicare or Initial Preventive Physical Examination Must be used within first 12 months of initially receiving Medicare Part B benefits.
G0438 Annual Wellness Visit Must be used if it is first Annual Wellness Visit AND more than 1 year after patient first qualified for Medicare Part B benefits.  Additionally, this code MAY NOT be used within one year of the G0402 encounter.
G0439 Subsequent Annual Wellness Visit Must be used more than 1 year after G0402

For more information about Medicare’s Annual Wellness Visit, and how MTBC’s patent-pending software CareConnector™ can help inform your patient’s of their eligibility for the AWV, while simultaneously increasing your revenue, please check out the following webinar.