Medicare annual Wellness visit schedule

[fh2000]

This question may have already been answered. I know after my initial 12 month joining traditional Medicare, I am eligible for a Wellness visit annually. My PCP does the same procedure like a physical with blood test, so it is worth for me to do it annually.

The timing of that, per my chat conversation with Medicare rep, is that it does not have to fall on the same date or later each year. It just needs to fall on the same month. So, my last year Wellness visit was on 11/22/23, and my available schedule starts on 11/1/24.

So, I scheduled one on 11/1/24, but my PCP office called and left a message that I will have to reschedule it to 11/22/24 or a later date.

Is there an official Q&A for such answer from Medicare regarding to this? I will need to send that to my PCP office.

 

[Koolau]

This question may have already been answered. I know after my initial 12 month joining traditional Medicare, I am eligible for a Wellness visit annually. My PCP does the same procedure like a physical with blood test, so it is worth for me to do it annually.

The timing of that, per my chat conversation with Medicare rep, is that it does not have to fall on the same date or later each year. It just needs to fall on the same month. So, my last year Wellness visit was on 11/22/23, and my available schedule starts on 11/1/24.

So, I scheduled one on 11/1/24, but my PCP office called and left a message that I will have to reschedule it to 11/22/24 or a later date.

Is there an official Q&A for such answer from Medicare regarding to this? I will need to send that to my PCP office.

I'm not quite sure what your last question is (about a Q&A.) But regarding changing the date of your PCP office visit, that is likely just their scheduling issue. My PCP always takes care of scheduling me for that visit and I just show up for it (and get the blood tests ahead of time.) I think it's a money maker for the doctors so they have some incentive to do it.

If I misunderstood your questions, I apologize.

 

[fh2000]

I'm not quite sure what your last question is (about a Q&A.) But regarding changing the date of your PCP office visit, that is likely just their scheduling issue. My PCP always takes care of scheduling me for that visit and I just show up for it (and get the blood tests ahead of time.) I think it's a money maker for the doctors so they have some incentive to do it.

If I misunderstood your questions, I apologize.

The issue is the exact date for the Wellness visit. Some private insurance has the requirement that next physical has to be 365 days and longer. That is what my PCP adheres to. Medicare Wellness schedule can be less than 365 days apart, as long as it falls on the same month as before.

I am looking for some Medicare published documents, Q&A online, or any other official evidence so I can send it to my PCP and let them know my schedule does not have to be 365+ days apart.

Hope this helps.

 

[Koolau]

The issue is the exact date for the Wellness visit. Some private insurance has the requirement that next physical has to be 365 days and longer. That is what my PCP adheres to. Medicare Wellness schedule can be less than 365 days apart, as long as it falls on the same month as before.

I am looking for some Medicare published documents, Q&A online, or any other official evidence so I can send it to my PCP and let them know my schedule does not have to be 365+ days apart.

Hope this helps.

Got it. Sorry.

I've never worried about it one way or the other as my PCP is so familiar with the rules that he won't do anything that jeopardizes such a visit. He does hundreds of these appointments for his patients per year and the office knows exactly how to schedule them so that MC is happy.

One thing I'll share with you is that MC sends ME an email saying "Hey, it's time for your annual wellness exam."

It looks like this:

---------
Dear Ko'olau,

This is a gentle reminder to reach out to your doctor to schedule your annual Medicare wellness visit, if you haven't already.

During your visit, you will work with your doctor to develop or update a personalized prevention plan based on your current health and risk factors. The plan includes preventive services that may be right for you. Use that plan to schedule appropriate preventive services throughout the year that could help you detect many health conditions early, when treatment is most effective.

Remember, Medicare covers the cost of your annual wellness visit and many other preventive services. You can also log in or create your Medicare account to view your eligible preventive services.

Sincerely,

The Medicare Team

-------------

As mentioned, I don't really have to do anything but show up (or ask for a different date/time - which the office will confirm is okay with MC.)

Best luck

 

[Texas Proud]

Just throwing out a question... do you have an advantage plan? Maybe they have the one year plus..

I just got mine scheduled and I do not think it is close to a year... it will be during my month of birth...

But, my Dr has an appointment with her the next hour after the wellness one... so two on the same day...

 

[rk911]

Over the last 9-yrs since I started Medicare our (my wife and I have a joint visit) annual Medicare wellness visits have morphed from December to June to January. The change was due to our travel schedule. We had no paperwork to file, don't know what paperwork, if anyrhing, the doc had to file. We always see our primary twice a year (type 2 diabetic) and our doc just seems to designate the first visit of the calendar year as the Medicare visit.

 

[ERD50]

.... The timing of that, per my chat conversation with Medicare rep, is that it does not have to fall on the same date or later each year. It just needs to fall on the same month. So, my last year Wellness visit was on 11/22/23, and my available schedule starts on 11/1/24.

So, I scheduled one on 11/1/24, but my PCP office called and left a message that I will have to reschedule it to 11/22/24 or a later date.

Is there an official Q&A for such answer from Medicare regarding to this? I will need to send that to my PCP office.

I am 100% certain that it is as your Medicare rep described, just in the same month, the date does not matter.

I've had this come up with two different doctors, and while I was waiting for him to return, I found it definitively on-line, and he thanked me and scheduled me for an earlier date next year in the same month, and that visit got paid normally.

It's frustrating that this is their business every day, all year, and they don't know what they are doing, and me, as an 'amateur', have to show them the ropes. I'll try to find it online for us.

 

[ERD50]

Here you go, I remembered the best search term was 11 months:

0077 - Annual Wellness Visit Billed Sooner than Eleven Whole Months Following the Initial Preventative Physical Examination | CMS

DescriptionThe Annual Wellness Visit (AWV) is not payable if an Initial Preventive Physical Examination (IPPE) has been paid within the previous eleven (11) whole months.Affected Code(s)G0439, G0402Applicable Policy References

www.cms.gov

The Annual Wellness Visit (AWV) is not payable if an Initial Preventive Physical Examination (IPPE) has been paid within the previous eleven (11) whole months.

https://communityhealth.mayoclinic.org/featured-stories/medicare-annual-wellness-visit

How often can I have an Annual Wellness Visit?

During your second year of Medicare Part B coverage and every year after, you may have one Annual Wellness Visit per year. The visit must be at least 11 full months after your previous year's visit.

This wording is a bit clearer (is a 'full month' from Jan 15 to Feb 15?):

How to avoid Medicare annual wellness visit denials

Identifying whether to code for an Initial Preventive Physical Exam (aka the “Welcome to Medicare” visit), an Initial Medicare Annual Wellness Visit (AWV) or a Subsequent Medicare AWV can be tricky.

www.aafp.org

At least 11 full months after G0438 or G0439. (Can be billed when you reach same calendar month as previous year's visit.)/

 

[fh2000]

Here you go, I remembered the best search term was 11 months:

0077 - Annual Wellness Visit Billed Sooner than Eleven Whole Months Following the Initial Preventative Physical Examination | CMS

DescriptionThe Annual Wellness Visit (AWV) is not payable if an Initial Preventive Physical Examination (IPPE) has been paid within the previous eleven (11) whole months.Affected Code(s)G0439, G0402Applicable Policy References

www.cms.gov

https://communityhealth.mayoclinic.org/featured-stories/medicare-annual-wellness-visit

This wording is a bit clearer (is a 'full month' from Jan 15 to Feb 15?):

How to avoid Medicare annual wellness visit denials

Identifying whether to code for an Initial Preventive Physical Exam (aka the “Welcome to Medicare” visit), an Initial Medicare Annual Wellness Visit (AWV) or a Subsequent Medicare AWV can be tricky.

www.aafp.org

Thank you.
I will bookmark these 2 links and forward to my PCP.