Annual Wellness Visits in Medicare Advantage and Fee-for-service

We continue to receive questions from Medical Groups about the Annual Wellness Visit (AWV).  As we've noted previously, CMS limits the AWV, either initial or subsequent, to once a year in FFS Medicare, and requires that health plans provide this service annually.   However, more and more groups are, as a best practice, performing the same sort of comprehensive health risk assessments (HRA) included in the AWV twice a year, and wonder if there is anything that prohibits them from doing so.

While CMS limits the use of the procedure codes G0438 or G0439 to once a year, neither CMS or SCAN limits the performance of a comprehensive health risk assessment to once a year.  SCAN encourages physicians to update the member's personalized prevention plan of service (PPS) and/or health risk assessment whenever they feel appropriate for their patient, given their patient's health and risk factors.

You may wish to incorporate this into the member's annual preventive services exam (99381-99397)-allowable by most health plans once per year,  or any extended or comprehensive outpatient E/M service (99214-99215).  There is no limitation to outpatient E/M services, and we encourage you to use them as an opportunity to make sure that your member's HRA and prevention plan of service are on track and members are obtaining the preventive services ordered.

In summary, while the procedure codes for the AWV are limited to once a year, there is nothing that stops a physician from performing any or all of the components of an AWV at any time during the year.  SCAN supports preventive care to ensure the highest level of health and independence for our membership, and recommend that physicians provide the HRAs, PPSs and other components of an AWV whenever they feel clinically indicated for their members.