How To Use HCPCS Code G0439

HCPCS code G0439 describes the annual wellness visit, which includes a personalized prevention plan of service (PPPS) and subsequent visit. This code is used to identify and bill for the services provided during an annual wellness visit, which focuses on preventive care and the development of a personalized prevention plan for the patient. In this article, we will explore the details of HCPCS code G0439, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0439?

HCPCS code G0439 is used to identify the annual wellness visit, which is a comprehensive preventive care visit for Medicare beneficiaries. This visit includes a personalized prevention plan of service (PPPS) and a subsequent visit. The purpose of this visit is to assess the patient’s overall health, identify any potential health risks, and develop a personalized prevention plan to address those risks. The subsequent visit allows for the implementation and monitoring of the prevention plan.

2. Official Description

The official description of HCPCS code G0439 is “Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit.” The short description is “PPPS, subseq visit.”

3. Procedure

1. The provider begins the annual wellness visit by reviewing the patient’s medical history, including any chronic conditions, medications, and previous preventive services.
2. A comprehensive physical examination is performed, including measurements of height, weight, blood pressure, and other relevant vital signs.
3. The provider assesses the patient’s cognitive function, including screening for depression and other mental health conditions.
4. A review of the patient’s functional ability and level of safety is conducted, including an assessment of activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
5. The provider discusses and provides counseling on various preventive services, such as vaccinations, cancer screenings, and other age-appropriate screenings.
6. A personalized prevention plan of service (PPPS) is developed based on the patient’s individual needs and risk factors.
7. The subsequent visit allows for the implementation and monitoring of the prevention plan, including any necessary follow-up tests, screenings, or interventions.

4. When to use HCPCS code G0439

HCPCS code G0439 should be used when billing for the annual wellness visit for Medicare beneficiaries. This visit is typically performed once a year and is intended for preventive care purposes. It is important to note that this code is specific to Medicare and may not be applicable for other insurance payers. Providers should check with the individual payer for their specific billing requirements and guidelines.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0439, healthcare providers need to document the following:

• Medical history, including chronic conditions, medications, and previous preventive services
• Comprehensive physical examination, including vital signs
• Cognitive function assessment and screening for depression
• Functional ability and safety assessment
• Counseling on preventive services
• Development of a personalized prevention plan of service (PPPS)
• Implementation and monitoring of the prevention plan during the subsequent visit

Providers should ensure that all documentation is accurate, complete, and supports the medical necessity of the services provided during the annual wellness visit.

6. Historical Information and Code Maintenance

HCPCS code G0439 was added to the Healthcare Common Procedure Coding System on January 01, 2011. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use since its addition and continues to be an important code for billing the annual wellness visit for Medicare beneficiaries.

7. Medicare and Insurance Coverage

HCPCS code G0439 is payable by Medicare and is used specifically for billing the annual wellness visit for Medicare beneficiaries. The pricing indicator code 13 indicates that the price for this service is established by carriers, meaning it is determined by Medicare or other insurance payers. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology, suggesting that the pricing for this service is determined by Medicare or other insurance payers using a specific methodology.

8. Examples

Here are five examples of when HCPCS code G0439 should be billed:

1. A 65-year-old Medicare beneficiary visits their primary care physician for their annual wellness visit. The physician reviews their medical history, performs a comprehensive physical examination, assesses their cognitive function, and develops a personalized prevention plan. The subsequent visit is scheduled for the implementation and monitoring of the prevention plan.
2. A 70-year-old Medicare beneficiary visits a geriatric specialist for their annual wellness visit. The specialist conducts a comprehensive assessment of their functional ability and safety, provides counseling on preventive services, and develops a personalized prevention plan. The subsequent visit is scheduled for the implementation and monitoring of the prevention plan.
3. A 75-year-old Medicare beneficiary visits a cardiologist for their annual wellness visit. The cardiologist reviews their medical history, performs a comprehensive physical examination, assesses their cognitive function, and develops a personalized prevention plan focused on cardiovascular health. The subsequent visit is scheduled for the implementation and monitoring of the prevention plan.
4. A 68-year-old Medicare beneficiary visits an endocrinologist for their annual wellness visit. The endocrinologist reviews their medical history, performs a comprehensive physical examination, assesses their cognitive function, and develops a personalized prevention plan focused on diabetes management. The subsequent visit is scheduled for the implementation and monitoring of the prevention plan.
5. A 72-year-old Medicare beneficiary visits a pulmonologist for their annual wellness visit. The pulmonologist reviews their medical history, performs a comprehensive physical examination, assesses their cognitive function, and develops a personalized prevention plan focused on respiratory health. The subsequent visit is scheduled for the implementation and monitoring of the prevention plan.