CurrentFlorida BluePolicy N/A

Medicare Annual Wellness Visit (AWV)

Defines coverage, coding, documentation, and billing guidance for Medicare Annual Wellness Visits for Florida Blue Medicare members, including initial and subsequent AWVs and telehealth considerations. Affects providers billing Florida Blue Medicare.

Policy Summary

PayerFlorida Blue

PolicyMedicare Annual Wellness Visit (AWV)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit appropriate HCPCS code (G0438 for initial AWV; G0439 for subsequent AWVs) and ensure provider accepts Medicare assignment to avoid member cost-sharing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1AWVs covered per calendar year

G0438Initial AWV code

G0439Subsequent AWV code

NoneMember cost sharing

Audio+videoTelehealth for risk adjustment

Coverage and Documentation Criteria

AWV coverage and documentation criteria

Covered when ALL of the following are met:

Initial Annual Wellness Visit (G0438) — Covered once within the first 12 months of Part B coverage. No member cost-share when provider accepts Medicare assignment.

Subsequent Annual Wellness Visit (G0439) — Covered once each calendar year after the initial AWV. No member cost-share when provider accepts Medicare assignment.

Frequency limit: One AWV per calendar year for Medicare Advantage members (after the initial G0438 where applicable).

Documentation of chronic conditions: Assess and document all active chronic conditions that coexist at the time of the visit and require or affect patient care or management; code all chronic conditions assessed, counseled, or that impact care.

Policy Summary

PayerFlorida Blue

PolicyMedicare Annual Wellness Visit (AWV)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit appropriate HCPCS code (G0438 for initial AWV; G0439 for subsequent AWVs) and ensure provider accepts Medicare assignment to avoid member cost-sharing.

SourceLink

On This Page

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HCPCS Codes and Frequency

AWV HCPCS codesHCPCSCovered

G0438	Initial Annual Wellness Visit — visit to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA)
G0439	Subsequent Annual Wellness Visit — visit to update and monitor patient healthcare needs

Frequency limit — AWV per calendar year covered

Frequency limitOne Annual Wellness Visit (AWV) per calendar year covered for Florida Blue Medicare members.

PurposeAWV is used to fulfill yearly reporting/documentation of chronic conditions and to create or update a Personalized Prevention Plan (PPP).

Coding implicationCode all chronic conditions documented at the time of the visit that required or impacted patient care.

PopulationApplies to Medicare Advantage (Florida Blue Medicare) members.

Billing, Submission, and Documentation Actions

Billing Rule

Billing and submission actions: use G0438 for initial AWV and G0439 for subsequent AWVs

Submit the appropriate HCPCS code for the type of AWV provided: G0438 for the Initial Annual Wellness Visit (within the first 12 months of Part B) and G0439 for Subsequent Annual Wellness Visits (once each calendar year after the initial AWV). Ensure the provider accepts Medicare assignment so the patient pays nothing when applicable.

G0438 — Initial AWV: visit to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA); covered once; performed face-to-face or telehealth. [[source cited above]]
G0439 — Subsequent AWV: visit to update and monitor patient healthcare needs; covered each calendar year after the initial AWV; performed face-to-face or telehealth. [[source cited above]]
Accept Medicare assignment to avoid member cost sharing.

Key Terms

Annual Wellness Visit

DefinitionAnnual Wellness Visit (AWV): visit to review medical conditions, engage the patient in preventive care planning, and create or update a Personalized Prevention Plan (PPP).

Covered HCPCS codesG0438 (Initial AWV) and G0439 (Subsequent AWV).

Coverage timingG0438: covered once within first 12 months of first Part B coverage; G0439: covered once each calendar year following the initial AWV.

Member cost sharingPatients pay nothing if provider accepts Medicare assignment.

ModalityPerformed face-to-face or via telehealth when allowed; used to develop/update PPP and perform HRA.

PPP / HRA — Personalized Prevention Plan and Health Risk Assessment

HRAHealth Risk Assessment (HRA): component of the AWV used to assess health risks and inform the Personalized Prevention Plan.

PPPPersonalized Prevention Plan (PPP): plan developed or updated during the AWV to address preventive services and risk reduction.

Role in AWVThe AWV is used to develop or update the PPP and to perform the HRA.

DocumentationPPP and HRA elements should be completed/updated during the AWV as part of preventive care planning.