Who is eligible for the AWV?
Medicare beneficiaries who are 65 years old and over are eligible for a preventive care Annual Wellness Visit every year at no cost to them.
Is the Annual Wellness Visit the same as a yearly physical?
No. The AWV is not a routine physical checkup that some seniors may get periodically from their physician or other qualified non-physician practitioner.
Are clinical laboratory tests part of the AWV?
No. The AWV does not include any clinical laboratory tests, but the Pharmacist may make referrals for such tests as part of the AWV, if appropriate.
Do deductible or coinsurance/copayment apply for the AWV?
No. Medicare waives both the coinsurance or copayment and the Medicare Part B deductible for the AWV.
Can I bill an electrocardiogram (EKG) and the AWV on the same date of service?
Generally, you may provide other medically necessary services on the same date of service as an AWV. The deductible and coinsurance/copayment apply for these other medically necessary services.
How do I know if a beneficiary already got his/her first AWV from another provider and know whether to bill for a subsequent AWV even though this is the first AWV I provided to this beneficiary?
You have different options for accessing AWV eligibility information depending on where you practice. You may access the information through the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) or through the provider call center Interactive Voice Responses (IVRs). CMS suggests providers check with their Medicare Administrative Contractor (MAC) to see what options are available to verify beneficiary eligibility.
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