What is a Medicare Annual Wellness Visit?

An Annual Wellness Visit (AWV) provides preventive care planning for Medicare beneficiaries aged 65 and older. It involves a review of health status and risk factors to improve quality of life.

Is an AWV the same as an annual physical?

No, AWVs focus on preventive care and wellness planning, whereas annual physicals include diagnostic tests and treatment for existing conditions.

What are the billing components of an AWV?

AWV billing includes a Health Risk Assessment, medical history review, measurements, cognitive and functional assessments, depression screening, a personalized prevention plan, and optional advance care planning.

What is not covered by a Medicare AWV?

AWVs do not cover detailed physical exams, vaccinations, medication management, real-time illness treatment, or diagnostic tests.

Who qualifies for an AWV and how much does it cost?

Patients covered under Medicare Part B for more than 12 months qualify for a free AWV annually with an in-network provider.

Do any restrictions apply?

Initial AWVs cannot take place within the first 12 months of Medicare Part B enrollment. Those early in enrollment may instead use the Welcome to Medicare visit.

Who can perform and bill for an AWV?

AWVs can be performed and billed by physicians, nurse practitioners, physician assistants, and other qualified medical professionals under physician supervision.

5 FAQs About Behavioral Health Integration

Michelle Ranken
Jun 18
4 min read

Doctor reviewing a tablet with a smiling older female patient during a Medicare Annual Wellness Visit, with overlay text reading “Annual Wellness Visits – 7 Frequently Asked Questions.”

With so many Americans lacking access to behavioral health care and a persistent stigma around mental health treatment, it should come as no surprise that the nation is grappling with a growing behavioral health crisis. That’s where Behavioral Health Integration (BHI) comes in. BHI, a CMS-defined care management program, incentivizes physicians to integrate behavioral health into primary care services to address a wide range of behavioral and physical health needs. Keep reading as we explore the basics of BHI and answer some frequently asked questions.

1. What Are Behavioral Health Integration Services?

BHI services aim to close the gap between medical and behavioral health care within primary and specialty care settings, allowing for wider accessibility to treatment. Behavioral health, which refers to mental health and substance use disorders, can greatly impact the treatment of many medical conditions.

2. What Are the Different BHI Models?

The Centers for Medicare & Medicaid Services (CMS) reimburses practices for two types of BHI services: General BHI and the Psychiatric Collaborative Care Model (CoCM). Both serve to integrate behavioral health into primary care, but they differ in how they're structured, the team members involved, and their respective billing codes. Each practice can choose the most appropriate model based on a variety of factors, including size, staff capabilities, patient population, etc.

We'll take a closer look at the specifics of the two models below.

General BHI

General BHI is a flexible model commonly found in primary care settings. Because a psychiatric consultant and designated behavioral health care manager aren't aren't required, this model tends to be more accessible to primary care practices.

Care Team Members Involved:

Treating (Billing) Practitioner: A physician or non-physician practitioner (NPP) that typically works in primary care but may have specialization in other areas (such as oncology or cardiology).
Potential Clinical Staff: Either the billing practitioner performs the service in full, or they delegate it to other qualified clinical staff members.

Psychiatric Collaborative Care Model

CoCM is a more structured, evidence-based model with stricter requirements for who is allowed to deliver care. CoCM is typically reserved for patients who require medication management.

Care Team Members Involved:

Behavioral Health Care Manager: A designated provider with formal education in a certain area of behavioral health, operating under the supervision of the billing practitioner.
Psychiatric Consultant: A medical professional who has received training in psychiatry and is qualified to prescribe medication.
Treating (Billing) Practitioner: A physician or NPP that normally works in primary care but may have specialization in other areas (such as oncology or cardiology).

3. Who is Eligible for BHI Services?

Because CMS does not limit billing and payment to a specific set of behavioral health conditions, BHI services are available (at the discretion of the billing practitioner) to any Medicare Part B patient living with a behavioral or psychiatric condition, or substance use disorder. The diagnoses can either be pre-existing or made by the billing practitioner and can be revised at a later time if needed.

4. Can BHI and Chronic Care Management Services Be Performed Concurrently?

Yes, BHI and Chronic Care Management (CCM) services can be performed concurrently, as there is often overlap in their patient populations. For example, a patient suffering from both diabetes and depression may lack the motivation to follow through with their prescribed medication, exercise, and diet regimen, making it crucial to address both conditions. Patients receiving both BHI and CCM services typically demonstrate better self-management of their chronic conditions and experience fewer costly hospitalizations.

Note: Practices also have additional opportunities for reimbursement since BHI and CCM are billed separately.

5. What Are the Billing Codes for BHI?

General BHI Billing Codes:

CPT 99484 includes at least 20 minutes of clinical staff time directed by a physician or other qualified health professional (QHP). Can only be billed once per calendar month.

CoCM Billing Codes:

CPT 99492 serves to bill the first 70 minutes of CoCM services in the first calendar month. Must be performed by a behavioral health care manager in collaboration with a psychiatric consultant and the billing practitioner or other QHP.

CPT 99493 serves to bill for the first 60 minutes of CoCM services after the initial month. Must be performed by the behavioral health care manager in collaboration with a psychiatric consultant and the billing practitioner or other QHP.

CPT 99494 serves to bill each additional 30 minutes beyond the initial time covered under CPT 99492 or 99493.

HCPCS G2214 includes initial or subsequent first 30 minutes of CoCM services in a calendar month. Must be performed by the behavioral health care manager in collaboration with a psychiatric consultant and directed by the billing practitioner or other QHP.

New Codes in 2025

CMS has added some additional codes that aim to support patients who are at risk of suicide or overdose, as follows:

HCPCS G0560 includes safety planning for those experiencing suicidal ideation or risk of overdose. Billed in 20-minute increments when performed by the billing practitioner.

HCPCS G0544 is meant for post-crisis follow-up care, covering up to four calls per calendar month.

Bridging the Gap Between Medical and Behavioral Health

Not only is BHI of paramount importance in tackling the behavioral health crisis, it also offers significant financial benefits by generating additional revenue for practices and preventing costly hospital stays. A pioneering communication and documentation solution, like Clinii Connect-AI, transforms how care teams engage with their patients by automatically transcribing calls and analyzing the patient’s emotional tone to generate actionable insights and maximize opportunities for reimbursement.

This content was created for and owned by Clinii. For all inquiries regarding distribution, please contact marketing@clinii.com.