Medicare annual wellness visit (AWV) reimbursement rate change 2022

UPMC Health Plan is working to promote the health of our Medicare members through the Medicare annual wellness visit (AWV). This visit is integral to our members’ health as it can be used as an opportunity for gap closure.

Effective Jan. 1, 2022, reimbursement for the annual wellness visit (AWV) will be adjusted and UPMC Health Plan will continue to pay above the Medicare fee schedule.

HCPCS/CPT code	Reimbursement Rate
G0438	$200
G0439	$175

To be eligible, the visit must be coded as a wellness visit ONLY (G0438 or G0439). The visit must be conducted within CMS-defined parameters and with appropriate clinical documentation in the medical record. Claims are subject to a UPMC Health Plan audit.

Please contact your physician account executive or call Provider Services at 1-866-918-1595 (TTY: 711) if you have any questions. Thank you for your continued support of our members.

The provider of care is ultimately responsible for providing accurate and compliant information on all submission of claims and/or billing information.