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Annual Wellness Visit to Provide Personalized Preventive Plan Benefit

Annual Wellness Visit Benefit Overview

Does a physician personally have to furnish an Annual Wellness Visit service?

No. An AWV service can be furnished by a:

• Physician;
• Nurse practitioner (NP), physician assistant (PA), or clinical nurse specialists (CNS); and
• A health professional, meaning a physician (a doctor of medicine or osteopathy), a qualified non-physician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist), or a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of such medical professionals who are working under the direct supervision of a physician, must furnish the AWV.

This means that a physician has flexibility in how he or she provides an AWV service to beneficiaries. A physician can personally furnish the service and bill for it. A physician can bill for the service if it is furnished by an NP, PA, or CNS employed by the practice. A physician can bill for the service furnished by a medical professional or team of professionals employed by the practice if he or she provides direct supervision. Direct supervision means that the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the duration of the AWV service. The physician does not need to be present in the exam room in which the service is performed.

The CMS commitment to this flexibility is evident from its response to a recommendation that the agency designate specifically who can be on the team of professionals and to assign roles for each team member. CMS responded that:

…it is better for the supervising physician to assign specific tasks to qualified team members (as long as they are licensed in the State and working within their state scope of practice). This approach gives the physicians and the team the flexibility needed to address the beneficiary's particular needs on a particular day. It also empowers the physician to determine whether specific medical professionals (such as occupational therapists) who will be working on his or her wellness team are needed on a particular day. The physician is able to determine the coordination of various team members during the AWV.

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