Medicare Wellness Exams
Annual Exam. Annual Physical. Welcome to Medicare. Annual Wellness. They’re all the same, right? Not so. Please take a look at the chart below for Medicare Physical Exam Coverage.
As you can see by this chart, Medicare has zero coverage for Annual Routine Physical Exams. These Preventive Medicine Evaluation and Management Services (E/M Section, CPT pgs. 47 – 49) are covered by many private payers, usually coverage prior to becoming a Medicare beneficiary.
These services may go by several names:
- Annual Exam
- Annual Physical
- Routine Physical
- Well Woman Exam (WWE)
It is important that everyone is aware of this in order to manage expectations. The scheduler needs to understand what kind of annual exam the patient is really scheduling for. The physician needs to understand this as well, because all (3) three of these services have different requirements that need to be met. The coder needs to understand the nuances between these services to ensure proper code selection based on the documented service. Lastly, the patient needs to be aware of what these different services mean, what will occur during the visit, and that there may be additional charges if the physician also evaluates existing medical conditions.
Medicare Resources:
CMS has many useful publications. Their Medicare Wellness Visits manual is a great manual for physicians and coders to gain a basic understanding of these services, their differences, and their coverage. CMS also has a manual geared towards patients, Patient Guide to Preventive Services, to help them understand the differences. Much like the childhood immunization cards, Novitas has published a card that patients can use to track their Medicare Preventive Services here.
Additional Resource Links:
- IPPE (Initial Preventive Physical Exam) (AKA: Welcome to Medicare)
- AWV (Annual Wellness Visits – Initial, Subsequent)
- Routine Physicals (Non-Covered Medicare Service)
- CMS Annual Wellness Visit Tip Sheet
- Medicare Preventive Services Quick Reference Chart
- CMS Patient Eligibility Tracker
- UTH Physicians Article – Understanding Medicare Wellness Visits (Internal)
Want to know more?
There is so much more to learn on this topic. If you would like more information, or specialty specific departmental education, please contact us:
Caroline.Wolbrecht@uth.tmc.edu – Compliance Education Program Manager
Betty.A.Babin@uth.tmc.edu – IM/Billing Compliance Program Manager
Brandi.Leonard@uth.tmc.edu – FM/Compliance Coding Analyst
Jessica.L.Metz@uth.tmc.edu – CDI Education Specialist