What is an Annual Wellness Visit and why is it important?

Historically, Medicare paid for acute or chronic illness treatment, not wellness promotion. However, when Medicare Managed Care Plans (MMCPs) were introduced, preventive care became reimbursable. MMCPs covered Complete Physical Evaluations (CPEs), hearing tests and additional services not typically covered by Traditional Medicare. Now, Traditional Medicare patients can receive preventive services as well under the term “Annual Wellness Visit” (AWV). Performed by an MD, APRN, RN or PA, an AWV is not the same as a CPE since it does not include a physical exam. It also mandates several elements that have not traditionally been included in a preventive physical, such as Health Risk Assessment (HRA), fall risk, depression screening, cognitive assessment and mobility assessment.

AWVs and CPEs have become central to ensuring that patients receive the preventive health services they need. It is during these visits that the “last and next colonoscopy,” “pneumonia vaccine” and other preventive tests are addressed to prevent cancer, obesity, heart disease and dementia.

NEMG recognizes the importance of these visits and the wide variation in practice patterns between providers. Rates of preventive visits range from 20 percent to 82 percent within our PCP patient panels. Those at the higher range tend to have more preventive care noted for their patients.

Relative Value Units (RVUs) are assigned to each type of visit. Insurers pay more for visits at a higher RVU, as they take more time and effort. Traditional Medicare will never cover a CPE--only the AWV. Managed Medicare Plans will cover either the CPE or AWV, and a few plans will even cover both in the same year. Here are the Annual Wellness RVU values:

  CODE

DESCRIPTION

RVU

  G0438

Initial Annual Wellness Visit

2.43

  G0439

Subsequent Annual Wellness Visit

1.5


It is critical that NEMG primary care offices become organized about offering a preventive visit yearly to as many eligible patients over age 65 as possible. During these visits, providers can update diagnosis codes, HCC codes and preventive health care to best reflect the amazing job we all do caring for patients in a proactive and preventive manner.