Built for the Whole Claim, Not One Code

Yes. CMS pays for G0438 and G0439 when the service is provided via telehealth. The component requirements do not change, so the capture layer has to work for a patient at home as well as one in an exam room.

A first AWV has a health risk assessment plus 13 numbered components: medical and family history, a current providers and suppliers list, measurements, cognitive impairment detection, depression risk review, functional ability and safety review, a written screening schedule, a risk factor and conditions list, personalized health advice with referrals, advance care planning at the patient's discretion, an opioid prescription review, a substance use disorder screen, and a physical activity and nutrition risk assessment. Subsequent visits have 12 numbered components with the health risk assessment first, and they drop the depression risk review and the functional ability and safety review.

Yes, and the patient's coinsurance and deductible are waived when three conditions all hold: it is delivered on the same day, by the same provider who furnished the AWV, and billed with modifier 33 on the same AWV claim. There is no CMS limit on how often advance care planning can be reported, though the cost-sharing waiver applies once a year with the AWV.

No. The completeness check, the frequency logic and the co-billing layer can sit alongside an existing tool, reading what it already captures. A practice that is happy with its current documentation workflow does not have to remove it to close the claim gap.