Temporary Billing Guidelines for Annual Wellness Visits and Initial Preventive Physical Examinations for Rural Health Clinics

The Centers for Medicare & Medicaid Services (CMS) identified an issue with the January 2013 quarterly release that is impacting the payment to Rural Health Clinics (RHCs) for Annual Wellness Visits (AWV) and Initial Preventive Physical Examinations (IPPE) services.

Although, AWV and IPPE are covered services for RHCs, the Fiscal Intermediary Shared System (FISS) is currently preventing the processing of these services at the all-inclusive payment rate.

Until system changes can be implemented in FISS, RHCs should follow the billing instructions outlined below to ensure there is no further delay in your Medicare payments:

• AWV services should be submitted to the Medicare claims administration contractor with revenue code 052X and HCPCS code G0438 or G0439. Please ensure no other services are reported on the claim with the same line item date of service as the AWV. 
• IPPE services should be submitted by itself on a separate claim to the Medicare contractor. When billing for an encounter/visit on the same day as an IPPE service, submit the first claim with revenue code 052X and no HCPCS/CPT code. The second claim should be submitted with revenue code 052X and HCPCS code G0402. 

Your Medicare contractor may have been holding these claims waiting for a system fix. Therefore, in order to prevent further delay in payments, your contractor will soon begin to return these claims to you. Please resubmit the claims using the billing guidelines as described above.

RHC providers should follow these billing guidelines until further instructions are given. Please contact your Medicare contractor if you have additional questions.