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Issue Number - Name
0077 - Annual Wellness Visit (AWV) Billed Sooner Than 11 Whole Months Following the Initial Preventative Physical Examination (IPPE)
Review Type
Automated
Claim Type
Physician/Non-Physician Practitioner
Region and State
RAC 1-4
All States
Date Approved
2018-01-09

Description

The Annual Wellness Visit (AWV) is not payable if an Initial Preventative Physical Examination (IPPE)  has been paid within the previous 12 months.

Affected Code(s)

  •  G0439, G0402

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, Section 140 
  • 42 Code of Federal Regulations, Section 1861, 411.15(a)(1) and 411.15 (k)(15)