Annual Wellness Visit (AWV) CPT CODE G0439, G0438

 The AWV is a preventive visit available to eligible beneficiaries, and identified by HCPCS codes G0438 (Annual wellness visit, including PPPS, first visit) and G0439 (Annual wellness visit, including PPPS, subsequent visit). Information, including definitions of relevant terms and coverage requirements for the AWV are included in Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, section 280.5.

The first AWV providing PPPS (HCPCS G0438) is a ‘one time’ allowed Medicare benefit and includes the following elements furnished to an eligible beneficiary by a health professional:

Review (and administration if needed) of a health risk assessment,

• Establishment of the individual’s medical/family history,

• Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual,

• Measurement of the individual’s height, weight, body mass index (or waist circumference, if appropriate), blood pressure (BP), and other routine measurements as deemed appropriate, based on the individual’s medical and family history,

• Detection of any cognitive impairment that the individual may have,

• Review of an individual’s potential risk factors for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose and recognized by national professional medical organizations,

• Review of the individual’s functional ability and level of safety, based on direct observation of the individual, or the use of appropriate screening questions or a screening questionnaire, which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations,

• Establishment of a written screening schedule for the individual, such as a checklist for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force (USPSTF) and Advisory Committee of Immunizations Practices (ACIP), and the individual’s health risk assessment, health status, screening history, and age-appropriate preventive services covered by Medicare,

• Establishment of a list of risk factors and conditions of which primary, secondary, or tertiary interventions are recommended or underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE, and a list of treatment options and their associated risks and benefits,

• Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition, and,

• Any other element(s) determined appropriate by the Secretary through the national coverage determinations process.

Subsequent AWVs providing PPPS (HCPCS G0439) include the following key elements furnished to an eligible beneficiary by a health professional:
Review (and administration, if needed) of an updated health risk assessment,

• Update of the individual’s medical/family history,

• Update to the list of current providers and suppliers that are regularly involved in providing medical care to the individual as that list was developed for the first AWV providing PPPS, or the previous subsequent AWV providing PPPS,

• Measurement of an individual’s weight (or waist circumference), blood pressure, and other routine measurements as deemed appropriate, based on the individual’s medical and family history,

• Detection of any cognitive impairment that the individual may have,

• Update to the individual’s written screening schedule as developed at the first AWV providing PPPS,

• Update to the individual’s list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, as that list was developed at the first AWV providing PPPS, or the previous subsequent AWV providing PPPS,

• Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs, and,

• Any other element determined appropriate by the Secretary through the national coverage determinations process.

See chapter 18 of this manual for additional information regarding preventive services that are separately covered under Medicare Part B.