#ThrowbackMemory

A long time ago, your kindergarten teacher (in all likelihood) gave you five differently colored balls and buckets and asked you to drop each ball into the bucket of the same color. The green ball needed to go into the green bucket, the red ball into the red bucket, and so on. And that is how, a long time ago, you learned how to match accurately.

An analogy between this throwback memory and the Current Procedural Terminology (CPT®) code—Annual Wellness Visits (AWV) equation may seem simplistic initially. However, I’ve found it to work well when trying to explain or understand the need for, and impact of, billing codes for Medicare AWVs. Especially because understanding these codes for Medicare AWVs provides clarity on – 

• Treatment expectation and affordability from a patient’s point of view
• Expected reimbursements for prescribed treatments from a payer’s perspective

The CPT® Codes—AWVs Equation

In the U.S., whoever is covered by Medicare Part B is entitled to free-of-charge AWVs. But this, you already know. My point here is that while most primary care clinics view AWVs as mere yearly physical examinations, fact is they can be used to forecast revenue figures and optimize the capacity of care teams.

Truth is that AWVs are critical care markers that bridge gaps in communication and treatment between consecutive annual physical examinations, helping primary care clinics to – 

• Update and better structure patients’ personalized care plans
• Document and create records of patients’ physical and mental health status to treat, and proactively prevent, health disorders

So where does the CPT® code aspect come into play in this scheme of things? Here’s where - There’s a specific CPT® code for a particular type of AWV, meaning that a certain AWV is identified by the unique CPT® code associated with it. The ball and bucket analogy fits right in, doesn’t it?

The table below shows the code and AWV correlation where only a specific code is placed against only one kind of AWV –

In addition to the standard CPT® codes associated with AWVs, Federally Qualified Health Centers (FQHCs) are allowed to use the special G0468 add-on code that lets them receive additional reimbursement. For instance, if an FQHC provides an Initial Preventive Physical Examination (IPPE), the clinic is eligible to bill for a reimbursement amount of $322 (G0402 + G0468). The coding also tells the CMS that an FQHC is providing the service. This way, these organizations become eligible to receive a much higher average reimbursement amount. Simply put, FQHCs can, in fact they are allowed to, bill for AWVs despite utilizing other or additional codes.

Revenue Projection and Capacity Optimization 

Against the CPT® Codes—AWVs equation backdrop, the default question is, “What is the one thing that a practice (such as yours) must do to forecast revenue figures and optimize your care team’s capacity?”

Answer – Just know the CPT® codes for Annual Wellness Visits (AWVs)! 

This knowing is easier said than done because most clinics lack an AI-guided care coordination solution that documents, and delivers, wellness visits using best practices. The absence of such a care platform – like Urban Health – translates into key details getting lost or being overlooked. 

Embracing care coordination software, on the other hand, enhances process efficiency and staff productivity, eventually helping streamline the creation of patient care plans, support staff workflows, simplify billing, and improve patient engagement and satisfaction.

The Annual Wellness Visit—Advance Care Planning Equation

Disclaimer - Advance Care Planning (ACP) is not an AWV type, unlike Initial Preventive Physical Examination (IPPE), Initial Annual Wellness Visit (IAWV) or Subsequent Annual Wellness Visit (SAWV). However, it has the potential to play an important role in the program.

Equation explained – ACP is defined as a process of understanding patients’ preferences for potential and future medical care, including end-of-life planning, power of attorney, and/or a living will. It gives practices the chance to create a patient-centric care plan; an AWV facilitates the creation of just such a plan.

More often than not, healthcare providers carry out ACP while an AWV is underway. Interestingly, the former is fully covered for patients under Medicare Part B if conducted during an AWV. Although ACP is free of cost and optional (part of AWVs), it is reimbursable for practices. Meaning that ACP can be billed concurrently with an AWV using CPT® code 99497 for the first 30 minutes and code 99498 for subsequent 30-minute sessions.

In Conclusion

Patient group-agnostic care coordination platforms like Urban Health are increasingly being adopted by practices that want to –

• Track all activities related to providing services during an AWV
• Ease billing difficulties
• Comply with the mandated rules and regulations for AWVs, and
• Schedule appropriate preventive services

It’s time you too benefited from such a care coordination platform. To know more, please click here.