Medicare Benefit: Annual Wellness Visits Covered The codes are G0438 and G0439.
The adult annual exam codes are as follows: Z00. 00, Encounter for general adult medical examination without abnormal findings, Z00.
This visit must be coded using CPT G0402. Once a patient has been enrolled for more than twelve months, the G0402 code will be rejected regardless of whether the IPPE visit previously took place or not. After a patient has been enrolled in Medicare for twelve months, they become eligible for an Annual Wellness Visit.
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.
Encounter for general adult medical examination without abnormal findings. Z00. 00 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z00.
Z00ICD-10 code Z00 for Encounter for general examination without complaint, suspected or reported diagnosis is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Z00.00ICD-10 Code for Encounter for general adult medical examination without abnormal findings- Z00. 00- Codify by AAPC.
A full physical exam, 99397, is different than an Annual Wellness Visit, G0438/G0439, or “Welcome to Medicare Exam”, G0402. A full physical 99397 or 99387 is NOT covered by Medicare and patients are responsible for the cost and can be billed.
Along with code G0438 or G0439, CPT code modifier -25 must be appended to the medically necessary E&M service. CPT guidelines define the -25 modifier as "Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service."
Z01.419Encounter for gynecological examination (general) (routine) without abnormal findings. Z01. 419 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z01.
If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance).
Medicare covers a “Welcome to Medicare” visit and annual “wellness” visits. While both visit types are available to Medicare recipients, recipients aren't required to participate in either visit type to maintain their Medicare Part B coverage.