Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Frequency limit - subsequent AWV billed within 12 months of previous AWV
Very CommonMedicare covers subsequent AWV (G0439) once every 12 months. Billing within 12 months of previous AWV triggers denial.
Common Causes
- • Visit scheduled <365 days from previous AWV
- • Practice used calendar year instead of 365-day rule
- • Patient had AWV at different practice within past year
Resolution Strategy
Verify date of previous AWV. If within 365 days, denial is correct per Medicare policy. Patient must wait until 365 days have passed.
2. Missing required AWV elements in documentation
CommonG0439 requires specific elements: health risk assessment, review of medical/family history, functional ability assessment, detection of cognitive impairment, personalized prevention plan. Missing elements trigger denials.
Common Causes
- • Health Risk Assessment not completed or documented
- • Cognitive impairment screening not performed
- • Personalized prevention plan not documented
Resolution Strategy
If all required elements were performed, enhance documentation to clearly show each component. If elements missing, may need to downgrade to appropriate E/M code.
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Ask a QuestionFrequently Asked Questions
CPT G0439 is the billing code for "Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit". It falls under the Procedures/Services category and is used by healthcare providers to bill insurance for this specific service.
Medicare pays approximately $126.47 for CPT G0439 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
The most common denial reason for CPT G0439 is "Frequency limit - subsequent AWV billed within 12 months of previous AWV". Medicare covers subsequent AWV (G0439) once every 12 months. Billing within 12 months of previous AWV triggers denial. Common causes include: Visit scheduled <365 days from previous AWV; Practice used calendar year instead of 365-day rule. Appeal success rate is approximately 10-30%.