This expanded coverage,
as established at 42 CFR 410.15, is subject to certain eligibility and other
limitations that allow payment for an annual wellness visit (AWV), including
personalized prevention plan services (PPPS), when performed by qualified
health professionals, for an individual who is no longer within 12 months after
the effective date of his/her first Medicare Part B coverage period, and has
not received either an initial preventive physical examination (IPPE) or an AWV
within the past 12 months. Medicare coinsurance and Part B deductibles do not
apply.
The AWV will include the establishment of, or update to, the individual’s
medical/family history, measurement of his/her height, weight, body-mass index
(BMI) or waist circumference, and blood pressure (BP), with the goal of health
promotion and disease detection and encouraging patients to obtain the
screening and preventive services that may already be covered and paid for
under Medicare Part B. Definitions relative to the AWV are included below.
Coverage is available for an AWV that meets the following requirements:
1. It is performed by a health professional; and,
2. It is furnished to an eligible beneficiary who is no longer within 12 months
after the effective date of his/her first Medicare Part B coverage period, and
he/she has not received either an IPPE or an AWV providing PPPS within the past
12 months.
Sections 4103 and 4104 of the ACA also provide for a waiver of the Medicare
coinsurance and Part B deductible requirements for an AWV effective for services
furnished on or after January 1, 2011.
