US · guidance
CMS Pub. 100-04, ch. 18, § 140.6
Common Working File (CWF) Edits
Effective for claims with dates of service on and after January 1, 2011, CWF shall reject:
• AWV claims for G0438 when a previous (first) AWV, HCPCS code G0438, is paid in history regardless of
when it occurred.
• AWV claims when a previous AWV, G0438 or G0439, is paid in history within the previous 12 months.
• Beginning January 1, 2011, AWV claims when a previous IPPE, HCPCS code G0402, is paid in history within
the previous 12 months.
• AWV claims (G0438 and G0439) billed for a date of service within 12 months after the effective date of a
beneficiary’s first Medicare Part B coverage period.
The following change shall be effective for claims processed on or after April 1, 2013. Typically, when a preventive
service is posted to a beneficiary’s utilization history, separate entries are posted for a “professional” service (the
professional claim for the delivery of the service itself) and a “technical” service (the institutional claims for a facility
fee). However, in the case of AWV services, since there is no separate payment for a facility fee, the AWV claim will
be posted as the “professional” service only, regardless of whether it is paid on a professional claim or an institutional
claim.
History
(Rev. 2575, Issued: 10-26-12, Effective: 04-01-13, Implementation: 04-01-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b081310b1079067f07ea9434b46e9596004fa181a29e7fc8e118559426ebfd2e
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