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The ABCs of Providing the Annual Wellness Visit


For dates of service on or after January 1, 2011, the Affordable Care Act allows for coverage of the Annual Wellness Visit (AWV), providing Personalized Prevention Plan Services (PPPS). All components of the AWV must be provided, or provided and referred, prior to submitting a claim for the AWV. Note that the AWV is a separate service from the Initial Preventive Physical Examination (IPPE), and that the AWV is not covered during the first 12 months of a beneficiary’s initial enrollment into Medicare Part B (Please refer HCPCS code G0402)

Elements of the FIRST AWV Providing PPPS (HCPCS code G0438)

ACQUIRE BENEFICIARY HISTORY

Establishment of the beneficiary’s medical / family history

At a minimum, collect and document the following:

Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments;

Use or exposure to medications and supplements, including calcium and vitamins; and

Medical events in the beneficiary’s parents and any siblings and children, including diseases that may be hereditary or place the beneficiary at increased risk.

Review of the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders

Use any 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 beneficiary’s functional ability and level of safety

Use direct observation of the beneficiary, or any 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 to assess, at a minimum, the following topics:

Hearing impairment;

Ability to successfully perform activities of daily living;

Fall risk; and

Home safety.

BEGIN EXAMINATION

An examination

Obtain the following:

Height, weight, body mass index (or waist circumference, if appropriate), and blood pressure; and

Other routine measurements as deemed appropriate, based on medical and family history.

Establishment of a list of current providers and suppliers

Include current providers and suppliers that are regularly involved in providing medical care to the beneficiary.

Detection of any cognitive impairment that the beneficiary may have

Assess the beneficiary’s cognitive function by direct observation, with due consideration of information obtained by way of patient reports and concerns raised by family members, friends, caretakers, or others.

COUNSEL BENEFICIARY

Establishment of a written screening schedule for the beneficiary, such as a checklist for the next 5-10 years, as appropriate

Base written screening schedule on:

Recommendations from the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP);

The beneficiary’s health status and screening history; and

Age-appropriate preventive services covered by Medicare.

Establishment of a list of risk factors and conditions of which the primary, secondary, or tertiary interventions are recommended or underway for the beneficiary

Include the following:

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 beneficiary and a referral as appropriate to health education or prevention counseling services

Includes referrals to programs aimed at:

Community-based lifestyle interventions to reduce health risks and promote self-management and wellness;

Weight loss;

Physical activity;

Smoking cessation;

Fall prevention; and

Nutrition.

Elements of SUBSEQUENT AWVs Providing PPPS (HCPCS code G0439)

ACQUIRE BENEFICIARY HISTORY

An update of the beneficiary’s medical / family history

At a minimum, collect and document the following:

Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments;

Use or exposure to medications and supplements, including calcium and vitamins; and

Medical events in the beneficiary’s parents and any siblings and children, including diseases that may be hereditary or place the beneficiary at increased risk.

BEGIN EXAMINATION

An examination

Obtain the following:

Weight (or waist circumference, if appropriate) and blood pressure; and

Other routine measurements as deemed appropriate, based on medical and family history.

An update of the list of current providers and suppliers, as that list was developed for the first AWV providing PPPS

Include current providers and suppliers that are regularly involved in providing medical care to the beneficiary.

Detection of any cognitive impairment that the beneficiary may have

Assess the beneficiary’s cognitive function by direct observation, with due consideration of information obtained by way of patient reports and concerns raised by family members, friends, caretakers, or others.

COUNSEL BENEFICIARY

Update to the written screening schedule for the beneficiary, as that schedule was developed at the first AWV providing PPPS

Base written screening schedule on:

Recommendations from the USPSTF and the ACIP;

The beneficiary’s health status and screening history; and

Age-appropriate preventive services covered by Medicare.

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

Include any such risk factors or conditions that have been identified.

Furnishing of personalized health advice to the beneficiary and a referral as appropriate to health education or prevention counseling services

Includes referrals to programs aimed at:

Community-based lifestyle interventions to reduce health risks and promote self-management and wellness;

Weight loss;

Physical activity;

Smoking cessation;

Fall prevention; and

Nutrition.


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