Medicare Wellness Visits (MWVs) improve patient outcomes, enhance care quality, and reduce healthcare costs. High-performing Accountable Care Organizations (ACOs) have greater than 50% MWV completion rates each year.
These free visits for Medicare patients, which may be conducted via Telehealth, are focused on preventive plans. During these appointments, providers identify risk factors and applicable intervention recommendations in a less acute, illness-focused visit. AWVs also grant the opportunity to capture or address quality measures specific to value-based contracts.
2024 brings changes to the basic requirements for each of the Medicare Wellness Visits as well as additional ICD-10 codes, screening and preventive services changes, and the introduction of new revenue-generating primary care services. These changes emphasize preventive care and streamline the documentation and billing process for these visits.
Here’s a comprehensive overview of what you need to know about these changes to Medicare Wellness Visits:
Changes to the Basics – New Requirements
- IPPE exam now includes Balance & Gait Evaluation
- AWVs
- Social Engagement included in Risk Factor Identification
- Suicidality evaluation included in Behavioral Health Risk Factor Identification
- Recommendations for primary, secondary, or tertiary interventions for identified risk factors or conditions
- Functional ability includes community safety evaluation, including driving when appropriate
- SDOH Risk Assessment optional with consent – only time patient has no co-pay for SDOH. If conducted via Telehealth, must be audio and video capable.
Changes to Screening & Preventive Services
- Bone Density, Colorectal Cancer Screening, and Hepatitis B Virtus Screening have new ICD-10 codes
- Breast Cancer Screening USPSTF Recommendation: Ages 40-74
- Diabetes Screening: Hemoglobin A1c with CPT Code 86036 is eligible Blood Glucose Test; also added 2 screenings within 12-month period following date of patient’s most recent diabetes screening
- Diabetes Self-Management Training: May use the initial 10 hours of training or annual 2 hours of DSMT for insulin-dependent through telehealth, when clinically appropriate. New billing advice for DSMT and Medical Nutrition Therapy included.
- HIV Screening: Additional information on blood panels’ inclusion for screening
New Revenue-Generating Primary Care Services
- Cognitive Assessment and Care Planning: New office-based services with billing codes and guidelines for sessions in PCP practices
- In-home Vaccination Options: Influenza, Pneumococcal, Hepatitis B, and COVID. Guidelines for billing in-home administration for vaccines.
- Medicare Diabetes Prevention Program: New billing codes and requirements for sessions.
- Psychiatric Advance Care Planning Requirements
Staying updated with these changes will ensure physicians provide comprehensive and compliant care to their Medicare patients. By integrating these new elements into wellness visits, providers can enhance the overall health and well-being of their patients.
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