Medicare annual wellness visit (AWV) reimbursement rate change 2022
Jan. 2022Important Notices
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.
Recent Announcements
The importance of PRD forms for complex patients and staying updated on changes
Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.Aug. 2025Important Notices
Important announcement: UPMC Health Plan retires MP.PA.147
This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.Aug. 2025Important Notices
CMS expands Medicare Advantage RADV audits to all eligible plans
On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.Aug. 2025What's New