1. 1
VITAMIN C
345 W Hancock Ave
Suite 202
Athens, GA 30601
(706) 658 • 6024
following the implementation of the Affordable
Care Act (ACA), more elderly individuals are able to
access care and preventive services needed to
improve current and future health outcomes.
One of the many services covered by Medicare is
the Annual Wellness Visit (AWV) which serves as an
opportunity to develop a personalized preventive
care plan. These visits provide patients and
physicians with the opportunity to craft a unique
preventive care plan that will likely improve future
health outcomes and care delivery.
Medicare patients may receive this annual service free-of-charge and physicians
may receive valuable reimbursement dollars if all specified requirements are
met. In 2013, the estimated average reimbursement for physicians across the
country for AWVs was $126.00. That year, only a reported 11 percent of patients
eligible for an AWV participated, leaving an estimated $3.8
billion unclaimed. While some physicians understand the ben-
efit of providing Annual Wellness Visits to all eligible patients,
they may remain frustrated by the barriers to performing these
visits. Other physicians may not understand the potential value
in providing these services and may view them as a waste of
practice time and resources.
At Vitamin C, we work hard to not only improve care delivery
and practice efficiency through our software, but also through
informational materials that may help your practice improve
its performance. This white paper details the requirements of
Annual Wellness Visits and the potential value in maximizing
your utilization of this Medicare service.
Only a reported 11
percent of patients
eligible for an AWV
participated, leaving
an estimated $3.8
billion unclaimed.
Medicare
ANNUAL
WELLNESS
VISITS
2. 2
With the introduction of a Medicare expansion following the passage of the
ACA, Medicare covers an Annual Wellness Visit (AWV) providing Personalized
Prevention Plan Services (PPPS) for beneficiaries who:
• Are not within the first 12 months of their first Medicare Part B coverage
period
• Have not received an Initial Preventive Physical Examination (IPPE) or
AWV within the past 12 months.
• Medicare pays for only one first AWV (CPT G0438) per beneficiary per
lifetime and pays for one subsequent AWV (G0439) per year thereafter.
These beneficiaries can now partner with their physicians to develop highly
personalized wellness plans and take part in many preventive screenings with
no additional cost to them.
CMS details the requirements for the initial and subsequent AWV, which is
outlined in the tables below.
Understanding Medicare Annual Wellness Visits
Performing Annual Wellness Visits
At the initial AWV,
physicians must
do the following:
Administer Health Risk Assessment (HRA)
Establish list of current providers and suppliers
Establish the beneficiary’s medical/family history
Review the beneficiary’s potential risk factors for depression,
including current or past experiences with depression or
other mood disorders
Review the beneficiary’s functional ability and level of safety
Assess basic health measurements (height, weight, BMI,
blood pressure, etc.
Detect any cognitive impairment the beneficiary may have
Detection of any cognitive impairment, for purposes
of this section, means assessment of an individual’s
cognitive function by direct observation, with due
consideration of information obtained by way of
patient report, concerns raised by family members,
friends, caretakers, or others.
Establish a written screening schedule for the beneficiary
(ex: checklist for next 5 years)
Establish a list of risk factors and conditions for which
the primary, secondary, or tertiary interventions are
recommended or underway
Furnish personalized health advice and a referral, as needed,
to health education or preventative counseling service
Initial Annual
Wellness Visit
3. 3
At the subsequent
AWV, physicians
must do the
following:
Assess basic health measurements (height, weight, BMI,
blood pressure, etc.)
Detect any cognitive impairment the beneficiary may have
Detection of any cognitive impairment, for purposes
of this section, means assessment of an individual’s
cognitive function by direct observation, with due
consideration of information obtained by way of
patient report, concerns raised by family members,
friends, caretakers, or others.
Update the written screening schedule for the beneficiary
Update the list of risk factors and conditions for which pri-
mary, secondary, or tertiary interventions are recommended
or underway for the beneficiary
Furnish personalized health advice and a referral, as needed,
to health education or preventative counseling service
Subsequent
Annual
Wellness Visit
Use the following Healthcare Common Procedure Coding System (HCPCS)
codes when filing claims for AWVs::
• G0438: Annual wellness visit; includes a personalized prevention plan of
service (PPPS), initial visit
• G0439: Annual wellness visit, includes a personalized prevention plan of
service (PPPS), subsequent visit
The AWV codes do not distinguish between new and established patients. The
initial AWV is billed the first time a Medicare beneficiary receives an AWV that
includes all of the services enumerated by CMS. The subsequent AWV code is
reported for any patients who have previously received an AWV service, wheth-
er at your practice or at any other practice.
The Centers for Medicare & Medicaid Services (CMS) did not specify the ICD-9
codes that should be used. Individual Part-B contractors may designate specif-
ic codes, but ICD-9 codes in the V70 range have typically been accepted. The
AWV is not the same as a “routine physical checkup” that some seniors may get
annually. Medicare does not cover these routine physicals.
Based on 2013 data, the estimated average reimbursement for physicians across
the country for AWVs was $126.00, with internal medicine and family practices
making the most use of these visits. Through this service overall, physicians col-
lected a total of approximately $448 million in 2013; however, only a reported 11
percent of patients eligible for an AWV participated, leaving an estimated $3.8
billion unclaimed. See the appendix for information, including how your state’s
2013 average reimbursement compares to the rest of the country and which pro-
viders are benefitting most from AWVs.
4. 4
The emphasis that the ACA has placed on preventive services and long-term
health outcomes can potentially benefit both the patient and the physician. By
completing the AWV, the patient has the opportunity to
review his or her health status with a physician. Once the
patient’s health is assessed, a detailed Personalized Preven-
tion Plan can be created and tailored to his or her unique
needs. This plan will be updated and reviewed with each
subsequent AWV. These appointments will serve as a guide
to patients over the next five to ten years of care while also
serving as valuable revenue opportunity for your practice.
These visits allow physicians to gain a comprehensive
overview of a patient’s current treatments and services,
including those that take place outside of the physician’s
own practice. This information can help the provider plan
future screenings and services. It may also save the physi-
cian time and money by eliminating the need for scheduling
several different appointments to address a variety of needs.
This saves time for the practice and offers the possibility
of increasing revenue by allowing the practice to see more
patients in a single day.
The Benefit of Annual Wellness Visits
These appointments
will serve as a guide
to patients over the
next five to ten years
of care while also
serving as valuable
revenue opportunity
for your practice.
How Vitamin C Can Help
Although Medicare patients are eligible for one AWV each year, utilization of
this service often remains low. Some physicians may be unsure of how to fulfill
the requirements of each AWV while others may be unsure of how to identify
and engage eligible patients for this service. Physicians may also be fearful of
dedicating too much time to completing this process. This opportunity to im-
prove patient health outcomes and to increase practice revenue is sacrificed due
to these perceived barriers.
By streamlining the patient recruitment and engagement process
and by providing educational materials for physicians and patients,
companies like Vitamin C can increase your practice’s utilization of
these services.
For more information about how Vitamin C can increase your utilization of
Medicare Annual Wellness Visits, please visit www.getvitaminc.com.
CMS Resource:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLN-
Products/downloads/AWV_chart_ICN905706.pdf
5. 5
Appendix
Vitamin C
Source: Center for Medicare and Medicaid Services
Internal Medicine*
Family Practice*
Nurse Practitioner
General Practice
Obstetrics/Gynecology
Physician Assistant
Cardiology
Emergency Medicine
Geriatric Medicine
Other Provider Types
Aggregate
Top 10 Providers of Wellness Visits
1,954,005
1,235,815
97,106
51,962
59,129
44,298
18,793
17,323
15,682
57,375
3,551,488
$ 248,358,385
$ 156,203,417
$ 10,663,033
$ 6,880,849
$ 6,830,235
$ 4,924,791
$ 2,535,303
$ 2,193,541
$ 2,065,900
$ 7,423,776
$ 448,079,230
Internal Medicine
and Family Practice
are the two highest
reimbursement
providers.
$ 127
$ 126
$ 110
$ 132
$ 116
$ 111
$ 135
$ 127
$ 132
$ 129
$ 126
PROVIDER TYPE BENEFICIARIES
PATIENTS WHO
COMPLETED AWV
ELIGIBLE PART B
MEMBERS
MISSED
REIMBURSEMENT
STATE
PAYMENTS
PAYMENTS UTILIZATION
AVERAGE
PAYMENTS
AVERAGE
PAYMENTS
Medicare Annual Wellness Visits
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
2,797
44,122
31,395
90,462
300,542
54,930
80,711
6,981
12,763
307,543
118,183
2,779
32,393
17,394
143,847
72,604
30,631
39,949
$ 419,468
$ 5,363,577
$ 3,789,361
$ 10,921,219
$ 41,421,450
$ 6,655,274
$ 10,405,305
$ 954,481
$ 1,663,714
$ 39,080,969
$ 14,414,040
$ 361,349
$ 3,812,849
$ 2,023,640
$ 19,007,038
$ 8,592,206
$ 3,749,250
$ 4,753,563
$ 150
$ 122
$ 121
$ 121
$ 138
$ 121
$ 129
$ 137
$ 130
$ 127
$ 122
$ 130
$ 118
$ 116
$ 132
$ 118
$ 122
$ 119
68,241
662,002
434,581
588,695
2,921,258
416,364
414,254
62,121
145,352
2,207,095
952,033
101,324
441,844
166,489
1,617,921
799,358
375,926
592,779
4%
7%
7%
15%
10%
13%
19%
11%
9%
14%
12%
3%
7%
10%
9%
9%
8%
7%
$ 9,814,683
$ 75,110,987
$ 48,664,353
$ 60,150,245
$ 361,193,630
$ 43,791,049
$ 43,000,539
$ 7,539,049
$ 17,283,570
$ 241,385,211
$ 101,699,458
$ 12,813,639
$ 48,194,815
$ 17,345,901
$ 194,774,873
$ 86,006,556
$ 42,264,278
$ 65,781,673
