So what's new in 2023 for Annual Wellness Visit CPT codes.
In this video, we'll break down everything you need to know about the CPT
codes for AWV, so that you can properly code
and bill for this program.
Hi, this is Seth from ThoroughCare.
Here at ThoroughCare, we're specializing in helping practices
manage bill and streamline reimbursements for value based programs like AWVs.
AWVs are designed as a critical care
marker that bridges gaps in the yearly physical exam
while developing and updating a patient's personalized plan of care.
If you'd like a reference guide for the AWV CPT codes
that we'll cover in this video, you can download one from our website.
There's a link in the description below.
So what are the 2023 updates for Annual Wellness Visits?
While there were no major changes to the AWV
rules and regulations and CMS has 2023 Final Rule,
but there was a significant increase in reimbursement to the Subsequent AWV,
which will cover. Keep in mind these codes are based on national averages
which may vary in your area. For the exact current rate
based on your location, visit the Physician Fee Schedule website.
Wellness visits come in three varieties.
These include the Initial Preventative Physical Examination, or IPPE,
the Initial Annual Wellness Visit, and each year
thereafter, a Subsequent Annual Wellness Visit.
All of these Annual Wellness Visits are very similar,
but it is important to understand some of the differences for billing purposes.
These include when each visit can be given and what type of patient
it is eligible for.
For a AWVs, there are billing codes for each visit
type as well as Advance Care Planning.
As a physician practice, Rural Health Clinic, and Federally Qualified Health Center,
you can bill for three types of Wellness Visits,
and there's an additional add on code for Federally Qualified Healthcare Centers.
For Initial and Subsequent Annual Wellness Visits,
an Advanced Care Planning code or codes can be tacked on
if you have the advanced care discussion during the AWV exam.
More on this to follow.
Let's start with the PPE, or the Initial Preventative Physical Examination.
The patient is billed using CPT code G0402.
This code can only be billed during the patient's first 12 months
of their enrollment in Medicare and is considered a once in a lifetime assessment.
If the patient misses this initial 12 month window,
they would not be eligible for the IPPE and would instead start with an Initial AWV.
A health risk assessment, or HRA, needs to be completed with the IPPE.
The current national average reimbursement is $167.
The next visit is the Initial Annual Wellness Visit,
and its billing code is G0438.
The Initial Annual Wellness Visit is practically identical to an IPPE,
except it can only be done 12 months after an IPPE, or if the patient
misses the eligibility window for the IPPE.
A health risk assessment also drives this visit and if an HRA was taken
the previous year, it can be used and updated for this current assessment.
The only main difference is that during the Initial AWV,
an optional cognitive exam can be included
as well as an Advanced Care Planning, or end of life discussion.
We'll talk more about the Advance Care Planning in just a little bit.
The current national average reimbursement for G0438 is $166.
The third and final Annual Wellness Visit is the Subsequent
Annual Wellness Visit and its billing code is G0439.
The Subsequent Annual Wellness Visit is the yearly follow up visit and is first
on 12 months after the Initial AWV and then every 12 months thereafter.
It is pretty much the exact same as the Initial AWV.
The patient completes and updates a health risk assessment to modify
and maintain their preventative care plan, including the optional cognitive exam.
Also the advance care planning talk.
The current national average reimbursement for G0439 is $130,
which is up significantly from the previous year.
Now let's look at the Advance Care Planning or ACP CPT code 99497.
It is important to note that Advance Care Planning is not a type of AWV,
but it can play a role in the program during the Initial and Subsequent AWV.
It is fully covered for patients under Medicare Part B,
if conducted during the Initial or Subsequent AWV.
ACP is a formal process to understand your patient's preferences for end of life
care and power of attorney options. During the Initial and Subsequent AWV
99497 can be billed for 30 minutes of time
and has a national average reimbursement of $83.
There is also an add on code for Advance Care Planning, code 99498.
It is for an additional 30 minutes over the first 30 minutes
and it has a national average reimbursement rate of $72.
And finally, the last AWV CPT code is a specialty
add-on code reserved for Federally Qualified Health Centers only, G0468.
G0468 allows FQHCs to receive additional reimbursement.
FQHCs are able to bill for the other AWV codes and then add this code to it.
The national average reimbursement for G0468 is $153.
This means much higher average reimbursements for FQHCs for AWV services.
For example, if a FQHC
were to provide an IPPE, the clinic would bill for G0402
and G0468 for a total average
reimbursement of $322.
So there you have it, 2023 codes and reimbursements for Annual Wellness Visits.
If you'd like to learn more about the specifics of each of the AWV segments,
there's a link in the description below to our Learning Center, where you can read
and learn more about AWVs as well as our other value-based programs.
And don't forget to download your free reference
guide from the billing codes we discussed in this video.
Please like and subscribe.
Thanks for watching.