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Medicare AWV: Added Services from Patients' Health Risk Assessments


The Medicare Annual Wellness Visit's Health Risk Assessments provide opportunities for ancillary income for physicians.

Many practices are realizing an additional $200 per patient or more annually for providing services to patients who undergo the Medicare Annual Wellness Visit (AWV).

CMS reimburses for asymptomatic annual alcohol, depression, and cancer FOBT screens. However, physicians may discover many conditions that need further treatment when patients complete their required annual Health Risk Assessment.

Some also have no copay like the AWV and some are CPT reimbursed with copays.

If a patient displays risk conditions for obesity, cardiovascular disease (CVD), cognitive impairment, allergies, fall risk, medical nutrition deficiency, or abdominal aortic aneurysm, the physician can implement treatment that is reimbursed in addition to the AWV at a later date.

Patients may also need treatment that is reimbursed if they answer positively to screens for alcohol, depression, smoking, kidney problems from medical nutrition, and HIV risk.

Here are some no copay reimbursement codes and average annual rates for these conditions:

AAA Scan -G0389 @ $110 (referred during initial IPPE only)

Obesity Counseling - G0447 @ $25.47 per session up to 20 per year if conditions met

CVD Risk Counseling - G0446 @ $25.47, one session annually

Tobacco Cessation Counseling - G0436 @ $13.62, three minutes to 10 minutes

Tobacco Cessation Counseling - G0437 @ $28.49, 15 minutes

Alcohol Counseling - G0443 @ $25.47, 15 minutes each for four annually

HIV Risk Counseling - G0445 @ $25.50, 20 minutes, two annually

Medical Nutrition Therapy - G0420 @ $107, one hour individual; G0421 group, $25

Here are CPT codes and rates with copays for health risks:

Allergy Testing - 95004 @ $6 to $6.50 per 60 anitigens at $360 for 10-minute test (plus, sublingual immunotherapy - SLIT with no shots, deliver or mail serum to patients)

Cognitive Impairment - 96120 @ $85 Neuropshychological Testing by Computer (10-minute test)

Fall Risk, Vestibular Testing - 92541, 42, 44, 45, 46, 47 @ $350 average

So, if your patient drinks, smokes, is overweight, has poor nutrition, is at risk for HIV, and has allergies, fall risk, and cognitive impairment, they need preventive help and treatment you can provide.

CMS will pay you up to $1,200 for your services which could save over $100,000 in future treatment expense and is a great investment for the future of Medicare and great benefits for your patients.

Find out more about Jeff Gatewood and our other Practice Notes bloggers.

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