Annual Wellness Visit (AWV)

The purpose of the AWV is to review the patient’s wellness and develop a
personalized prevention plan.

Humhealth Annual Wellness Visit image

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
Humhealth awv screenshot

Key Features

  • Health Risk Assessment

    Health Risk
    Assessment

  • Cognitive impairment assessment

    Cognitive impairment
    assessment

  • PHQ-2 and PHQ-9 Depression assessment

    PHQ-2 and PHQ-9
    Depression assessment

  • Functional Ability and Level of Safety

    Functional Ability and
    Level of Safety

  • Beneficiary Checklist for the next 5 to 10 years

    Beneficiary Checklist
    for the next 5 to 10
    years

  • Auto Generation of Recommendations

    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 time

    20 minutes

  • Average Reimbursement

    $48.65

  • Billing Code

    99492

  • BHI Type

    CoCM First Month

  • Behavioral Healthcare Manager
    (or) Clinical staff threshold time

    70 minutes

  • Average Reimbursement

    $162.18

  • Billing Code

    99493

  • BHI Type

    CoCM Subsequent months

  • Behavioral Healthcare Manager
    (or) Clinical staff threshold time

    60 minutes

  • Average Reimbursement

    $129.38

  • Billing Code

    99494

  • BHI Type

    CoCM Add-on code

  • Behavioral Healthcare Manager
    (or) Clinical staff threshold time

    30 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 time

    20 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 time

    70 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