G0438 Annual wellness visit Medicare reimbursement rates in Utah

The initial Medicare Annual Wellness Visit is preventive planning, not a head-to-toe physical. A physician, nurse practitioner, physician assistant, clinical nurse specialist, or medical professional under a physician’s direct supervision, such as a health educator or registered dietitian, usually furnishes it in primary care. Required elements include a health risk assessment, medical and family history, a list of providers and suppliers, routine measurements, cognitive and depression-risk assessments, functional and safety review, review of opioid prescriptions and substance use risk, and a written screening schedule and personalized prevention plan.

Report G0438 for the beneficiary’s first AWV with any practice, once per lifetime, after more than 12 months of Part B coverage and at least 12 months after any IPPE. Use G0439 for later AWVs. Document the assessment, required elements, and written plan furnished to the patient. Medicare waives the AWV deductible and coinsurance. A separately supported problem-oriented E/M visit can be reported with modifier 25 on the E/M; its usual cost sharing remains. If separately furnished with the AWV, advance care planning may be reported with 99497 and modifier 33 for its cost-sharing waiver.