CMS updates billing code requirements for IPPE and AWV services

Wednesday, April 3, 2024

CMS recently released MLN Matters MM13548 to update billing code requirements for initial preventive physical examination (IPPE) and annual wellness visit (AWV) services in Chapter 12, Section of the Medicare Claims Processing Manual.

Facilities should use the following Healthcare Common Procedure Coding System (HCPCS) codes to bill IPPE and AWV services:

  • G0402 (IPPE; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment)
  • G0438 (AWV; includes a personalized prevention plan of service [PPS], initial visit)
  • G0439 (AWV; includes a personalized PPS, subsequent visit)

However, CMS instructed facilities not to bill Current Procedural Terminology (CPT®) codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for Medicare services covered by HCPCS codes G0402, G0438, and G0439.

CMS also updated guidance on the Advance Beneficiary Notice of Non-coverage (ABN) in Chapter 12, Section 30.6.2 of the Medicare Claims Processing Manual. The agency stated that, although it is not required, physicians are strongly encouraged to provide an ABN to beneficiaries when providing and billing for a preventive medicine service.

These updates take effect on May 15. Revenue integrity professionals can review Medicare Claims Processing Transmittal 12546 for more information.