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What you need to know: Medicare annual wellness visits and preventive physical exams

04/11/2018

ConnectiCare Medicare members are eligible for one annual wellness visit (AWV) and one preventive physical exam per calendar year. Both services can be done during the same office visit. Here’s how you code them properly.

The differences
An AWV allows providers to review a patient’s health status and create a personalized preventive care plan. The AWV can also address care coordination, costs and gaps in care. The AWV can include assessments of the patient’s health risks, cognitive function, functional screening, medication reconciliation and other risk factors.

An AWV can also include the following:

  • Mental health screening, using screening tests recognized by national medical professional groups, such as PHQ-2 or PHQ-9.
  • And, other preventive screening referrals based on gaps in care, such as those for colon cancer, breast cancer and bone mineral density.

It’s important to note that an AWV can be performed by a licensed medical professional who works under the direct supervision of a physician, such as a health educator or registered dietitian. The AWV does not have to be done by a physician.

On the other hand, an annual preventive physical exam must be performed by a licensed physician. This exam allows a head-to-toe assessment with a comprehensive exam that may include lab testing, immunizations and preventive screening referrals.

We ask PCPs to remind patients that they are only covered for one physical exam with no cost-share per calendar year. If patients undergo another physical exam in the same calendar year ─ for example from their ob/gyns ─ they may be charged a cost-share.