Wellcare Annual Preventative Visit Guide
Date: 05/06/24
Wellcare Annual Preventative Visit Guide
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Wellcare members are covered for:
| Annual Wellness Visit (AWV) | This unique to Medicare visit allows you and your patient to meet and discuss their health to create a personalized prevention plan. | 1 per calendar year | G0438, G0439* |
| Routine Physical Exam (RPE) | This Medicare Advantage Supplemental beneft is a comprehensive physicalexamination to screen for disease and promote preventative care. | 1 per calendar year | 99381-99387**(new patient) 99391-99397**(established patient) |
*Contracted Federally Qualified Health centers (FQHC) should bill in accordance with contract requirements.
**Can be billed with the AWV with a modifier 25.
Topics to discuss during your patient’s Annual Wellness Visit (AWV):
| Update patient’s medical record: includingdemographics, other treating providers and family history | Assess bladder leakage and care options |
| Conduct a Social Determinants of Healthassessment | Create a preventative screening schedule andrefer members for tests, labs, X-rays (eye exams, colonoscopy, mammograms), counseling and careprograms |
| Discuss Advanced Care planning | Complete the health risk assessment, includingfunctional abilities, ADLS, instrumental ADLs andcreate an action plan |
| Screen for cognitive impairment, includingdepression, mental wellness and emotional health | Create patient’s list of balance/fall risk factors andconditions; including interventions and treatmentoptions |
| Conduct medication reconciliation and extendday fll opportunities (mail order or 90 days at retail) | Check routine measurements: height, weight,blood pressure, etc. |
| Complete pain and functional assessments;including use of Durable Medical Equipment (DME) | Review current opioid prescription and screen for potential Substance Use Disorders (SUDs) |
Topics to discuss during your patient’s Routine Physical Visit:
- Heart, lung, head/neck, abdominal, neurological, dermatological,extremities and gender specifc exam
- Health History
- Vital signs
Quick reference – Medicare Advantage care
For People with Diabetes:
- Annual diabetic retinal eye exam
- Review adherence of diabetes medications(consider 90-day flls for maintenancemedications) and evaluate the addition of a statin to help prevent heart and blood vessel diseases
- Blood pressure monitoring
- Testing and control of HbA1c
- Kidney function tests
- Medical attention for nephropathy
As Needed:
- Osteoporosis screening and management after fracture
Care for Older Adults:
- Medication review and reconciliation by physician
- Functional status assessment
- Pain assessment
- Advance care planning
- Depression screening
Important Cancer Screenings:
- Colon cancer screening (Colonoscopy, Fit DNA test, Cologuard)
- Breast cancer screening
- Prostate cancer screening
- Lung cancer screening
Adult Vaccinations:
- COVID-19 – initial and follow-up
- Infuenza – yearly
- Pneumococcal – one time (may need booster)
- Meningococcal
- Tetanus, diphtheria, pertussis (Td/Tdap)
- Zoster (shingles)
- Hepatitis A
- Hepatitis B
Tips to Ensure Healthy Oucomes:
- Always share tests and screenings results with members, and discuss how they can access them, via a patient portal
- Be sure to submit all applicable conditions, via IDC 10 codes
- Leverage CPT Category II codes to ensure outcomes in order to reduce chart collection events