Annual Wellness Visit (AWV)
The purpose of the AWV is to review the patient’s wellness and
develop a
personalized prevention plan.
1. Acquire Beneficiary information
- a. Administer HRA
- b. Establish the beneficiary’s medical/family history
- c. Review the beneficiary’s potential risk factors for depression, including current or past experiences with depression or other mood disorders
- d. Review the beneficiary’s functional ability and level of safety
2. Begin Assessment
-
a. Health Risk Assessment
1) CAGE Questionnaire
2) Activities of Daily Living
3) Instrumental Activities of Daily Living - b. Cognitive impairment assessment
- c. PHQ-2 and PHQ-9 Depression assessment
3. Counsel Beneficiary
- a. Establish a written screening schedule for the beneficiary, such as a checklist for the next 5 to 10 years, as appropriate
- b. Establish a list of risk factors and conditions for which the primary, secondary, or tertiary interventions are recommended or underway for the beneficiary
- c. Furnish personalized health advice to the beneficiary and appropriate referrals to health education or preventive counselling services or programs
- d. Furnish, at the discretion of the beneficiary, advance care planning services

Key Features
-
Health Risk
Assessment -
Cognitive impairment
assessment -
PHQ-2 and PHQ-9
Depression assessment -
Functional Ability and
Level of Safety -
Beneficiary Checklist
for the next 5 to 10
years -
Auto Generation of
Recommendations
HCPCS Codes and Descriptors
- HCPCS Code
- Billing Code Descriptors
- Average Reimbursement
-
HCPCS Code
G0438
-
Billing Code Descriptors
Annual wellness visit; includes a personalized prevention plan
of service (PPS), initial visit -
Average Reimbursement
$175.32
-
HCPCS Code
G0439
-
Billing Code Descriptors
Annual wellness visit, includes a personalized prevention plan
of service (PPS), subsequent visit -
Average Reimbursement
$119.16
Behavioral Health Integration (BHI) Services
Integrating behavioral health care with primary care (“behavioral
health integration” or “BHI”) is an
effective strategy for improving outcomes for people with mental or
behavioral health conditions.
Types of BHI Services
- 1. General
- 2. Psychiatric Coordinated Care Management (CoCM)
Care team members
- 1. Treating (Billing) Practitioner
- 2. Beneficiary
- 3. Potential Clinical Staff
Service Components
Initial assessment
- Initiating visit (if required, separately billed)
- Administration of applicable validated rating scale(s)
- Systematic assessment and monitoring, using applicable validated clinical rating scales
- Care planning by the primary care team jointly with the beneficiary, with care plan revision for patients, whose condition is not improving
- Facilitation and coordination of behavioral health treatment
- Continuous relationship with a designated member of the care team
Billing Codes
- Billing Code
- BHI Type
-
Behavioral Healthcare Manager
(or) Clinical staff threshold time - Average Reimbursement
-
Billing Code
99484
-
BHI Type
General BHI
-
Behavioral Healthcare Manager
(or) Clinical staff threshold time20 minutes
-
Average Reimbursement
$48.65
-
Billing Code
99492
-
BHI Type
CoCM First Month
-
Behavioral Healthcare Manager
(or) Clinical staff threshold time70 minutes
-
Average Reimbursement
$162.18
-
Billing Code
99493
-
BHI Type
CoCM Subsequent months
-
Behavioral Healthcare Manager
(or) Clinical staff threshold time60 minutes
-
Average Reimbursement
$129.38
-
Billing Code
99494
-
BHI Type
CoCM Add-on code
-
Behavioral Healthcare Manager
(or) Clinical staff threshold time30 minutes
-
Average Reimbursement
$67.03
-
Billing Code
G0511
-
BHI Type
General BHI for Rural Health
Clinic (or) Federally Qualified
Health Center -
Behavioral Healthcare Manager
(or) Clinical staff threshold time20 minutes
-
Average Reimbursement
$67.03
-
Billing Code
G0512
-
BHI Type
CoCM for Rural Health Clinic
(or) Federally Qualified
Health Center -
Behavioral Healthcare Manager
(or) Clinical staff threshold time70 minutes First
month and 60 minutes
Subsequent months -
Average Reimbursement
$145.96
Principal Care Management (PCM)
Principal Care Management is also known as PCM and it is very similar to Medicare’s Chronic Care Management (CCM) with a few key differences. Under the new PCM codes, specialists may now be reimbursed for providing their patients with care management services that are more targeted within their own particular area of specialty. This program addresses the need for classification of treatment for patients with one chronic condition.
HCPCS Codes and Descriptors
- HCPCS Code
- Billing Code Descriptors
- Duration
- Average Reimbursement
-
HCPCS Code
G2064
-
Billing Code Descriptors
PCM service provided by Physician
-
Duration
30 minutes
-
Average Reimbursement
$52
-
HCPCS Code
G2065
-
Billing Code Descriptors
PCM service provided by Clinical Staff
-
Duration
30 minutes
-
Average Reimbursement
$52