Medicare recouping payments for Annual Wellness Visits

In provider based clinics, the group reports both a facility and a professional fee to Medicare for its services.  CMS is recouping payments when its contractors have paid for both a facility and a professional fee for AWV.

CMS recently released a transmittal and MedLearn Matters article about recouping money when Medicare Contractors had paid for both a facility and professional fee for Annual Wellness Visits.  The AWV is not a covered service under the Outpatient Prospective Payment System, but many provider based clinics reported these services in the same manner as office visits and the Welcome to Medicare Visit.

CMS, however, states that wellness visits are different from the Welcome to Medicare Visit and other office services and these do not have both a professional and technical component.   For billing purposes, either the facility or the physician may report the AWV but not both.  Specifically, this refers to codes G0438 and G0439.  It does not change the reporting of the Welcome to Medicare Visit G0402, which may still be reported with both a facility and professional fee.

The transmittal is 1190, CR 8153 released Feb. 15, 2013.

The MLN Matters article is MM8153.