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
HPV Vaccination Resources
To help protect against cancers later in life, it is important to increase HPV vaccination rates in adolescents starting at age 9. According to the Centers for Disease Control and Prevention, HPV vaccination is routinely recommended at age 11 or 12, but the vaccine can be given starting at age 9.1 The Pennsylvania Cancer Coalition cites the following potential benefits of initiating the HPV vaccine series at age 9:2Mar. 2025Important Notices
Special notice: Important policy changes
Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.Mar. 2025Important Notices
CME Webinar: Essential Best Practices for Newborn Care: Ensuring Healthy Beginnings Through Comprehensive Care
Please join us for a live, CME-accredited webinar on Wednesday, May 7, from noon to 1 p.m. that will provide an overview of newborn care.Feb. 2025Education/Webinars