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A GREAT way to get Patients to ENGAGE and the timing is RIGHT

A GREAT way to get Patients to ENGAGE and the timing is RIGHT

                                      *This is a visit that will reimburse anywhere from $210-$290

Volume is down, staff may be furloughed or idle during this Pandemic. It is time to start reaching out to your Medicare patients and encourage them to address some potentially much needed and timely services. Let's get them on the schedule and that means doing so either in person or ideally through Telehealth (Audio/Video). It may be time to address some of the preventative services that are covered and ultimately benefit your Patients and build connections to you and your Practice. Now is the time to take advantage of these services.

For more Preventative Services Follow this link:https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html

Please reach out to your Nexsys Account Manager for any direction or questions.

Annual Wellness Visit Initial/Subsequent HCPCS Code GO438/9

Follow this link for resources to help guide you in providing this service:



Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit

Lay Term:

Use this code when the provider performs a patient’s first annual wellness visit, or AWV, as a part of the annual wellness program. At this visit, the provider takes the patient’s medical history, assesses risk factors, and provides a personalized prevention plan of service.

Clinical Responsibility
A provider assesses the patient on his first visit as a part of the annual wellness program. The patient interview and assessment includes such services as obtaining the patient's:

  • medical, family and social history
  • review of medical conditions
  • functional ability and tests
  • detection of cognitive impairments
  • physical examinations of the patient’s height and weight, blood pressure measurement
  • establishing lists of risk factors and disease conditions
  • The provider also formulates a screening schedule for the patient for the next ten years
  • He goes on to prepare a list of care providers and suppliers involved with the patient’s health care
  • He further establishes any facility needs the patient may need to provide health advice and other programs to the patient including smoking cessation, and or physical activity and nutrition, to reduce identified risk factors. This code is for the first visit.

Blood pressure: The force that the blood exerts on the walls of all the blood vessels that supply blood to all the organs and parts of the body.

Cognitive: Brain's intellectual activity such as thinking, remembering, reasoning, etc.

Functional ability: Measurement of an individual's ability to execute routine tasks such as standing smoothly and independently.

Risk factor: A physical trait or a habit that makes one more susceptible over others for a particular disease.

Smoking cessation: Quitting the highly addictive habit of smoking tobacco.

Use G codes for professional healthcare procedures and services that would otherwise be coded in CPT® but for which there are no CPT® codes or for which Medicare requires a G code instead of a similar CPT® code. 

Medicare policies cover the service this code includes. Coverage for this service is once in lifetime, and not within 12 months of Medicare enrollment or initial preventive physical examination, IPPE, visit. (For initial, otherwise use Subsequent)

*Include an E/M code if your provider needs to treat the patient for a specific diagnosis during the visit and performs and documents the work associated with a problem oriented E/M service. Report the appropriate E/M code with modifier 25, Significant, separately identifiable evaluation and management service by the same provider on the same day of the procedure or other service, along with the supporting diagnosis, plus the wellness visit code.

The purpose of the AWV is to provide a preventive planning service, not take care of problems the patient has at the same time. As per the federal register, problems are to be addressed at a different visit, except when there is a rare circumstance that warrants dealing with a problem at the time of the AWV. Payers may allow billing a problem E/M service along with modifier 25. Injections would be coded separately, but Medicare may decide to deny the injection procedure at the time of the AWV because they have decided to bundle it. 

You can use the appropriate CPT® code from code range 99381 to 99386 for Initial comprehensive preventive medicine evaluation and management of an individual of various age groups.

Annual Advance Care Planning (estimated 16 minutes) CPT Code 99497

Follow this link for resources to help guide you in providing this service:


Please reach out to your Nexsys Account Manager for any direction or questions.


Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate


Codes 9949799498 are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms. An advance directive is a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time. Examples of written advance directives include, but are not limited to, Health Care Proxy, Durable Power of Attorney for Health Care, Living Will, and Medical Orders for Life-Sustaining Treatment (MOLST). 

When using codes 9949799498, no active management of the problem(s) is undertaken during the time period reported. 

Lay Terms:

The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30 minutes of face to face time that the provider spends.

Clinical Responsibility
The provider discusses and shares advance care planning for up to 30 minutes with a patient, his family, or an individual representing the patient, regarding the future healthcare needs of the patient. Advance care planning focuses on the patient and involves both the patient and the provider responsible for their care. It provides the patient with an opportunity to develop and express their preference for care depending upon their current and anticipated future health status and treatment options available. It empowers the patient to make an informed decision about their future care including their advanced care decisions. The provider may enter the actual plan on forms specifically designed for that purpose within the patient’s record. 

Advance directive: A document that enables a person to make provision for his health care decisions in case if in the future, he becomes unable to make those decisions; include documents such as a living will and a medical power of attorney.

Other qualified healthcare professional: An individual who is qualified by education, training, licensure or regulation, who performs a professional service within his scope of practice and independently reports that professional service; these professionals are distinct from the clinical staff. 

*When the provider spends an additional 30 minutes of face–to–face time with the patient for advance care planning, use 99498; list separately in addition to the code for primary procedure.

For a checklist of other great Preventative Services to offer please follow this link:


Now is the time to reach out to all Patients who are due for their annual well visit, address any chronic conditions and take some time to address their Advanced Care Planning.
Jeff Robertson, CMPE
Nexsys Billing & Practice Management

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About the Author: Jeff Robertson, CMPE, FMC

Jeff Robertson, CMPE, FMC
A passion for Healthcare is the best way to describe Jeff Robertson. He has a unique, varied and extensive background in Healthcare that covers a wide array of experience encompassing 30 years. Jeff is board-certified by the MGMA as a Medical Practice Executive (CMPE) and Financial Management Certified (FMC) and a proud active MGMA member. Jeff is also an active member of the Healthcare Business Management Association (HBMA) and continues to keep his knowledge current and focused on future trends and initiatives and how they affect our clients and their Clinics. Jeff has been actively running the Revenue Cycle Management and Practice Management divisions since 1997. Jeff Robertson has spent over 27 years in Independent Physician Clinics with a special focus on Medical Billing/Revenue Cycle Management, Healthcare IT, Clinical Workflow Analysis, and Medical Bookkeeping and Financials for Independent Medical Practices. His passion for teaching, consulting, and finding a better, more efficient way to build processes into a clinic has led to him being labeled the “Practice Fixer.” To date, he has installed, configured, trained, and consulted over 400 Independent Physician Clinics across the country and has learned valuable lessons from each of them to share with all future clients.