Beginning March 1, 2018, we'll no longer pay for the enhanced annual wellness visit for our Medicare Advantage plan customers.
The enhanced wellness visit is represented by the HCPCS code S0250 (Comprehensive geriatric assessment and treatment planning performed by the assessment team) when an assessment and/or care of two or more chronic conditions was conducted and billed along with the Annual Wellness visit code.
Effective March 1, 2018, we will only reimburse the following codes:
- G0438 - Annual wellness visit, includes a personalized prevention plan of service (PPS), initial visit
- G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit
These annual wellness exams should continue to be billed with one of the following appropriate ICD-10 Diagnosis codes as the primary diagnosis:
- Z00.00 - Encounter for general adult medical examination without abnormal findings, or
- Z00.01 - Encounter for general adult medical examination with abnormal findings
When stable chronic and complex conditions are identified or discussed during the wellness exam, code them as secondary and tertiary diagnoses.
If a condition is significant enough to require additional work, consider adding E/M service code with a modifier 25 (following CPT guidelines).
Visiant uses Medicare's payment policies, which can be viewed at CMS.gov.