Does Medicare Provide any Documentation on the AWV?

Clinical Care

Yes, please select this link to view the document directly from CMS.

If a beneficiary has never had an IPPE, does Medicare cover an Ultrasound Screening for AAA ordered based on an AWV referral?

Clinical Care

No, Medicare does not cover the ultrasound screening for AAA when ordered based on an AWV referral. Medicare coverage for a one-time ultrasound screening for AAA depends on the beneficiary meeting certain eligibility requirements, including receiving a referral as a result of an IPPE.

Can I bill a separate Evaluation and Management (E/M) service at the same visit as the AWV?

Clinical Care

Medicare may pay for a significant, separately identifiable, medically necessary E/M service (Current Procedural Terminology [CPT] codes 99201 – 99215) billed at the same visit as the AWV when billed with modifier -25. That portion of the visit must be medically necessary to treat the beneficiary’s illness or injury, or to improve the functioning of a malformed body member.

Do deductible or coinsurance/copayment apply for the AWV?

Clinical Care

No, coverage for the AWV is provided as a Medicare Part B benefit. Medicare waives both the
coinsurance or copayment and the Medicare Part B deductible for the AWV.

Is the AWV the same as a beneficiary’s yearly physical?

Clinical Care

No, the AWV is a preventive wellness visit and is not a “routine physical checkup” that some seniors may receive every year or two from their physician or other qualified non-physician practitioner. Medicare does not cover routine physical examinations.

How do I bill Medicare for the follow-up visit(s)?

Clinical Care

Use standard E&M coding with procedures if required.  This is the same billing to Medicare you’ve been using for years.

What if my patients complain about being treated by a nurse, mid-level or CMA instead of a physician?

Clinical Care

Tell them honestly that the wellness visit is a data gathering session that leads to a visit with the doctor if warranted.  The data gathered by the nurse or mid-level will be turned into a very comprehensive report that will be used by the physician to determine if follow-care is needed and/or how much care is required.  Tell the patient that this is very focused care that will give them the best results for their personal plan of health.

How can a medical professional be qualified to do the wellness visit?

Clinical Care

Remember that the wellness visit is a data gathering visit only.  There is no diagnosing occurring during the wellness visit.  The nurse (or other medical professional) is gathering information from the patient.  That information is being analyzed by WellTrackONE and its proprietary health risk assessment (HRA) engine and the WellTrackONE report is produced for the physician.  At THAT point, the physician begins problem-focused care, follow-up testing, etc that may lead to a diagnosis.

View our Document: WellTrackONE – 2016 Who May Perform the Annual Wellness Visit for more information about this topic.

Do I need to schedule the patient for a follow-up visit?

Clinical Care

We recommend that you tell the patient that if the risk factors are significant then you would like to have them come back in for follow-up care.  That is completely up to the physician to make that call once s/he sees the WellTrackONE report.

Do I draw blood or urine for the wellness visit?

Clinical Care

If the patient’s risk factors warrant further testing, you may draw blood at the point of care and Medicare will normally pay for the visit.  You must use an appropriate ICD10 code to indicate why you are drawing blood or performing additional tests.  You cannot draw blood for AWVs as a screening component; there must be an indicated risk to justify the reason for the additional test(s).