New Medicare Coverage for Annual Wellness Visits

Starting January 2011, Medicare will add coverage for annual well visits (AWV), not just the Welcome to Medicare visit.

There are two new HCPCS Level II codes: G0438 and G0439. G0438 is an initial visit for annual wellness. G0439 is a subsequent annual wellness visit. Both include a personalized prevention plan of service.

According to CMS, these codes can be billed as incident-to and will be paid using the same relative value units (RVUs) as 99204 (office/outpatient visit, new, $155.23) for the initial AWV and 99214 (office/outpatient visit, est., $99.93) for subsequent AWVs.

2011 HCPCS Level II Released

The Centers for Medicare & Medicaid Services (CMS) posted the 2011 HCPCS Level II files . There are 147 new codes and modifiers and more than 286 codes have been deleted. A new Table of Drugs and Index has also been released.

A quick overview of changes include a large number of G codes and injectables. Additional changes are in the Q temporary section with new flu tracking codes and the addition of pass-through codes. Most of the deleted codes come from the G section.

New Flu codes

There are five new temporary HCPCS codes that became effective Oct 1, 2010 for flu vaccines in persons over three years of age but they will not be recognized by Medicare processing systems until Jan 1 2011, when the code 90658 will no longer be recognized.

Four of the five new temporary influenza vaccine codes identify a specific name brand of vaccine and should be reported accordingly. They are Q2035 (Afluria), Q2036 (Flulaval), Q2037 (Fluvirin), and Q2038 (Fluzone). The fifth code, Q2039 (NOS), is for all other influenza vaccines that do not fall under one of the name brands listed above.

These should be billed in addition to the administration code for the vaccine.