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Annual Wellness Visit to Provide Personalized Preventive Plan Benefit

Annual Wellness Visit Benefit Overview

Does the establishment of the AWV service benefit revoke the ability of a physician to bill a beneficiary for a Medicare non-covered CPT comprehensive preventive medicine service, CPT 99381-99397?

No. CMS states that a physician can continue to bill a beneficiary for a non-covered comprehensive preventive medicine service, such as CPT 99387, which describes such a service to a new patient 65 years and older, as long as the service does not fit the description of the specific description of an AWV service or the Welcome to Medicare visit service.

A physician can also continue to bill Medicare for a “medically necessary” service, e.g. CPT 99213, that addresses an acute or chronic problem during an encounter at which a CPT periodic comprehensive preventive service is furnished. The Medicare payment policy that directs the physician to bill the beneficiary the physician’s established charge for the CPT comprehensive preventive medicine service minus the established charge for the “medically necessary” service still applies.

ACP is aware that imprecise reference to the AWV benefit as a “free annual physical” can misinform patients, result in patient expectations that will require extensive conversations, and, at worst, strain physician-patient relationships. The College is urging the government and other stakeholders to describe the AWV precisely when making beneficiaries aware of the new benefit. ACP, in a beneficiary education resource on the ACA it developed jointly with AARP, describes the AWV benefit as “an annual visit to your doctor to find out if you are at risk of developing a medical condition and to develop a personal prevention plan.” The ACP-AARP “The New Health Care Law: How it Might Affect You” is at http://www.acponline.org/advocacy/where_we_stand/access/new_hc_law.pdf if you want to distribute it to your patients.

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