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
CME Webinar Series: Introducing Physicians and their teams to Value-Based Health Care
Please join us for a new CME-accredited webinar series on value-based care. This series is designed to introduce practicing physicians and their teams to value-based health care. Over the course of six sessions, we will define the components of value and identify the tools necessary to deliver high-value care for a population.Feb. 2026Education/Webinars
Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions
Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.Feb. 2026Education/Webinars
February 2026 UPMC for You and UPMC Community HealthChoices formulary update
Pulmicort Flexhaler has a new distributor, Rubicon Holding. National Drug Codes (NDCs) for Pulmicort Flexhaler from Rubicon Holding are not included in the Medicaid Drug Rebate program and are not covered under the Medicaid Prescription Drug Program. Pulmicort Flexhaler NDCs from the previous manufacturer, H2 Pharma, have been discontinued but may be billed/dispensed until supplies are exhausted.Feb. 2026Pharmacy Updates