Medicare Advantage Annual Wellness Visits
Defines scheduling, codes, visit purposes, and billing rules for Welcome to Medicare (IPPE), Annual Wellness Visits (AWV), and Annual Physical Exams for HealthPartners Medicare Advantage members; affects providers billing Medicare Advantage and Original Medicare members.
No material clinical or coverage changes in this revision.
Preventive Visit Coverage Criteria
Preventive visit coverage criteria
Covered when the following scheduling, coverage, and billing rules are met:
ALL of the following
IPPE timing
- IPPE (Welcome to Medicare Visit) is scheduled within the first 12 months of Medicare coverage and is covered for Medicare Advantage and Original Medicare (CPT 60402).
AWV timing
- For HealthPartners Medicare Advantage plans, an Annual Wellness Visit (AWV) is allowed once per calendar year (codes G0438, 60439).
- For Original Medicare, an AWV is allowed once every 12 months (codes G0438, 60439).
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