Did You Know: Heart disease is the leading cause of death for men and women in the United States? Now is a great time to be screened for cardiovascular disease.
If you have been enrolled in Medicare Part B for over a year, you are entitled to an Annual Wellness Visit (AWV). These covered visits are designed to help you develop or update a personalized prevention plan which can help prevent disease and disability.
During your visit, your doctor will assess your current health and risk factors. He or she will likely ask questions about your health and ask you to fill out a questionnaire or “Health Risk Assessment” form. By answering these questions honestly and to the best of your ability, you can help your provider develop a personalized prevention plan to keep you fit and healthy. Aside from the Health Risk Assessment, your provider will likely ask about your medical and family history, update your current prescriptions, take measurements (height, weight, blood pressure, etc.) and more.
Your Annual Wellness Visit is a way for your health care provider to make sure you have all the information you need to continue living a happy, healthy life.
Here’s everything your AWV could include:
It’s Covered By Medicare Part B!
Your Annual Wellness Visit is covered under Medicare Part B, under two conditions:
- You only complete this visit once every 12 months.
- Your doctor or healthcare provider sticks to the checklist above.
As long as both of these things are true, you won’t pay anything and your Medicare Part B deductible doesn’t apply.
However, you may have to pay coinsurance or the Medicare Part B deductible if your doctor or provider performs services outside of what is covered under the Annual Wellness Visit and those services aren’t a part of preventive and screening services. Here’s what isn’t covered as part of your AWV:
Preventive and Screening Services
During your visit, your provider should give you a screening schedule for appropriate preventive services. The screening schedule is a checklist that lets you know which preventive services you should take advantage of.
The following preventive services are completely covered by Medicare Part B:
- Alcohol misuse screening & counseling
- Diabetes self management training
- Nutrition therapy services
- Obesity screening & counseling
- Sexually transmitted infections screening & counseling
- Tobacco use cessation counseling
- Flu Shots
- Hepatitis B shots
- Pneumococcal shots
- Bone mass measurements (bone density)
- Cardiovascular disease screening
- Cervical & vaginal cancer screening
- Colorectal and prostate cancer screenings
- Depression screenings
- Diabetes screenings
- Glaucoma tests
- Hepatitis C screening
- HIV screening
- Lung cancer screening
- Mammograms
Women's Health
Your Medicare Annual Wellness Visit is a great time to ask your doctor about Medicare-covered preventive services that apply specifically to women and get advice on what you can do to improve your health. Some of the leading causes of death in women include heart disease, cancer, diabetes, influenza and pneumonia. Medicare provides preventive services that can help detect disease and improve and maintain women’s physical and mental health. These services include the following:
- Cardiovascular disease screenings
- Cervical and vaginal cancer screenings
- Mammograms
- Immunizations
- Sexually transmitted infections screening and counseling
- Obesity screening and counseling
- Diabetes screening
- Depression screenings
Men's Health
In the U.S., the leading causes of death for men age 65 and over include heart disease, cancer, chronic lower respiratory diseases, diabetes, influenza and pneumonia. Medicare provides the following preventive services that can help detect and prevent disease in men including:
- Cardiovascular disease screenings
- Diabetes screening
- Flu and pneumococcal shots
- Colorectal and prostate cancer screenings
- Tobacco use cessation counseling
Download your Medicare Annual Wellness Visit Guide
To get the most out of your Annual Wellness Visit, download our Medicare Annual Wellness Visit guide. This digital guide can be printed out at home and includes a preparation checklist where you can write down questions you have for your provider or make notes of things you need to take to your appointment.
Information For Providers
If you’re a healthcare provider, there are a few things you need to know before completing a Medicare AWV. The Centers for Medicare & Medicaid Services offers a provider checklist that details everything an AWV should include.
When filing claims for AWVs including a personalized prevention plan of service (PPPS), use the following Healthcare Common Procedure Coding System (HCPCS) codes:
- G0438 - initial visit
- G0439 - subsequent visit
The checklist also includes other frequently used billing codes, frequently asked questions and resources for providers. You can find the complete checklist here.
Sources:
Medicare.gov: https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html
https://www.medicare.gov/coverage/preventive-and-screening-services.html
CMS.gov: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2013-06-06-Mens-Health.html?DLPage=1&DLEntries=10&DLFilter=men%27s%20&DLSort=0&DLSortDir=descending
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2015-04-30-Women-Health.html This web page provides content for informational purposes and is not a substitute for professional medical advice or treatment for specific conditions. MedicareSupplement.com is owned and operated by TZ Insurance Solutions LLC, a licensed insurance agency. Not Connected with or endorsed by the U.S. government or the federal Medicare program.
