APCM Billing Code Setup for AWV | Tile Healthcare

Ensure Initial (G0438) and Subsequent (G0439) AWV rates are updated according to the latest CMS Medicare Physician Fee Schedule.

Configure APCM codes in your EHR to allow for concurrent billing with AWV when requirements for both are met during the same month.

Set up AI call center triggers to automatically schedule follow-up AWVs when a patient is identified as APCM-eligible during a screening.

Ensure billing software is prepared to append Modifier 25 if a separate E/M service is performed alongside the AWV and APCM initiation.

Develop EHR templates that combine the Health Risk Assessment (HRA) with APCM care plan initiation requirements to save documentation time.

Use AI-driven HRA tools to identify chronic conditions that qualify the patient for APCM during the pre-visit outreach call.

Document verbal or written consent for APCM services during the AWV encounter, explaining the cost-sharing and 24/7 access benefits.

Use the AWV findings to draft the initial APCM care plan, ensuring all CMS-required elements are captured in a single visit.

Deploy AI voice agents to call patients who have missed their AWV, emphasizing the transition to comprehensive APCM care.

Check for two or more chronic conditions during the AWV that are expected to last at least 12 months for APCM qualification.

Record the time spent on APCM-related activities during the AWV to ensure it meets the minimum threshold for concurrent billing.

Ensure all screenings (depression, falls risk, cognitive) performed during AWV are linked to the APCM care plan objectives.

Conduct monthly internal audits to ensure G0438/G0439 claims are not being denied when billed alongside APCM codes.

Document how the patient can access care 24/7, a requirement for APCM that can be established during the AWV.

Perform and document a full medication reconciliation during the AWV, which serves as a core component of the APCM care plan.