CMS Pub. 100-04, ch. 12, § 30.6.1.1

Wellness Visit (AWV)

(Rev. 12546; Issued: 03-14-24; Effective: 05-15-24; Implementation: 05-15-24)

F. HCPCS Codes Used to Bill the IPPE or AWV

1. HCPCS Codes Used to Bill the IPPE

For IPPE and EKG services provided prior to January 1, 2009, the physician or qualified NPP

shall bill HCPCS code G0344 for the IPPE performed face-to-face, and HCPCS code G0366

for performing a screening EKG that includes both the interpretation and report. If the primary

physician or qualified NPP performs only the IPPE, he/she shall bill HCPCS code G0344 only.

The physician or entity that performs the screening EKG that includes both the interpretation

and report shall bill HCPCS code G0366. The physician or entity that performs the screening

EKG tracing only (without interpretation and report) shall bill HCPCS code G0367. The

physician or entity that performs the interpretation and report only (without the EKG tracing)

shall bill HCPCS code G0368. Medicare will pay for a screening EKG only as part of the

IPPE. HCPCS codes G0344, G0366, G0367 and G0368 will not be billable codes effective on

or after January 1, 2009.

Effective for a beneficiary who has the IPPE on or after January 1, 2009, and within his/her 12-month enrollment period of Medicare Part B, the IPPE and screening EKG services are billable

with the appropriate HCPCS G code(s).

The physician or qualified NPP shall bill HCPCS code G0402 for the IPPE performed face-to-face with the patient.

The physician or entity shall bill HCPCS code G0403 for performing the complete screening

EKG that includes the tracing, interpretation and report.

The physician or entity that performs the screening EKG tracing only (without interpretation

and report) shall bill HCPCS code G0404.

The physician or entity that performs the screening EKG interpretation and report only,

(without the EKG tracing) shall bill HCPCS code G0405.

2. HCPCS Codes Used to Bill the AWV

For the first AWV provided on or after January 1, 2011, the health professional shall bill

HCPCS G0438 (Annual wellness visit, including PPPS, first visit). This is a once per

beneficiary per lifetime allowable Medicare Part B benefit. Do not bill for AWV services using

CPT codes 99381-99397.

All subsequent AWVs shall be billed with HCPCS G0439 (Annual Wellness Visit, including

PPPS, subsequent visit). In the event that a beneficiary selects a new health professional to

complete a subsequent AWV, the new health professional will continue to bill the subsequent

AWV with HCPCS G0439. Do not bill for AWV services using CPT codes 99381-99397.

NOTE: For an IPPE or AWV performed during the global period of surgery, refer to chapter

12, §30.6.6 of this chapter for reporting instructions.