well visit definition

What is the difference between a physical exam and a Medicare Wellness Visit?

Published by Medicare Made Clear®

The difference between a physical exam and a Medicare Wellness Visit is basically the difference between your doctor focusing on what’s wrong versus on what’s right. Each is important, depending on the situation.

When you’re sick or in pain, you want to get better. A physical exam helps your doctor figure out what the problem is and what needs to be done.

When you’re healthy and feeling good, you want to stay that way. A wellness exam helps your doctor understand what’s working for you and how to best support your continued health and well-being.

Your doctor performs specific tasks in each of these two exams in order to achieve its purpose. See below for a chart that lists some of the services that may be covered in a physical exam versus a Medicare wellness visit, or that may be covered in both.

NOTE: this chart is not complete and you should ask your physician what is covered and your Medicare plan provider to understand how different health services may or may not be covered.

What’s included in a physical exam?

An annual physical exam is an assessment of your body’s health. The primary purpose is to look for health problems.

During the exam, your doctor uses his or her senses – mainly sight, touch and hearing – to gauge how your body is performing. Based on what’s learned, your doctor may ask you to have tests to discover or rule out possible health problems.

The list below shows some of the things your doctor may do during a physical exam.

Visually check your body overall for signs of existing health issues

Look into your eyes, ears, nose and throat for potential problems

Listen to your heart and lungs to detect irregular sounds

Touch parts of your body to feel for abnormalities

Test your motor function and reflexes

Perform pelvic and rectal exams

Measure your height, weight and blood pressure

As a rule, Medicare does not cover an annual physical. The exam and any tests your doctor orders are separate services, and you may have costs related to each depending on your Medicare plan.

What’s included in a Medicare Wellness Visit?

A Medicare Wellness Visit, also called a wellness exam, is an assessment of your overall health and well-being. The primary purpose is prevention – either to develop or update your personalized prevention plan. Medicare covers a wellness visit once every 12 months (11 full months must have passed since your last visit), and you are eligible for this benefit after you have had Part B for at least 12 months.

During the exam, your primary care provider combines information from the visit with your medical record to gauge your risk for common preventable health problems such as heart disease, cancer and type 2 diabetes. Based on what’s learned, your doctor creates your personal prevention plan with a checklist of screenings you need to have.

The list below shows some of the things your doctor may do during a wellness exam.

Review your health risk assessment (questions you answer about your health)

Confirm your medical and family history

Record your current prescriptions and providers

Measure and document your height, weight, and blood pressure

Look for signs of memory loss, dementia, or frailty

Document your health risk factors and treatment options

Provide personalized health advice

Develop a screening schedule (like a checklist) for the preventive services recommended for you

Medicare Part B covers an annual wellness exam and many preventive screenings with no copay or deductible. However, you may have to pay a share of the cost for certain recommended tests or services. And while it’s not mandatory, there are very good  reasons to have a wellness exam  every year.

What is a "Welcome to Medicare" visit?

Medicare Part B covers a "Welcome to Medicare" visit. This visit is also called an Initial Preventive Physical Exam (IPPE). You are eligible for this benefit once within the first 12 months you are enrolled in Part B

What to expect at your "Welcome to Medicare" visit

During the visit your provider will:

Record and evaluate your medical and family history, current health conditions and prescriptions.

Check your blood pressure, vision, weight and height to get a baseline for your care.

Make sure you are up-to-date with preventive screenings and services, such as cancer screenings and shots.

Order further tests, depending on your general health and medical history.

You do not pay a copayment for your "Welcome to Medicare" visit. The Part B deductible does not apply to the cost of the visit either.

After the visit, your provider will give you a personalized prevention plan or checklist with the screenings and preventive services recommended for you. These services are not part of the "Welcome to Medicare" visit. You may have to pay a co-payment for the recommended services when you get them. Your Part B deductible may also apply.

Learn more about what to expect at your Medicare wellness visit.

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What Happens During a Wellness Visit?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Importance of a Wellness Visit

• What to Expect
• How to Prepare

A wellness visit is a health check-up that is typically conducted on an annual basis. It involves visiting your healthcare provider to check your vitals, screen for health conditions , and develop a healthcare plan for your needs.

The aim of a wellness visit is to promote health and prevent disease and disability.

This article explains why annual wellness visits are important, what you can expect during the process, and how to prepare for it.

These are some reasons why wellness visits are important.

Prevent Diseases

Most healthcare visits are categorized under diagnostic care; when you have a health problem, you visit a healthcare provider who assesses your symptoms, diagnoses your condition, and prescribes a treatment plan.

A wellness visit on the other hand is a preventative healthcare measure. The aim of preventative healthcare is to help you maintain good health and prevent health problems before they develop. The goal is to help you live a longer, healthier life.

Wellness visits assess your lifestyle, evaluate health risks, and screen for health conditions, in order to prevent health problems or catch them in the early stages. Instead of waiting to see a healthcare provider once you have a health problem, the idea is to be proactive about your health and work with your healthcare provider to prevent health problems.

People tend to think that it’s fine to skip their annual wellness visit if they’re feeling healthy. However, a 2021 study notes that wellness visits can play a role in catching chronic health conditions early, as well as helping people control for risk factors that could cause them to develop health issues down the line.

Reduce Medical Costs

Wellness visits can help prevent disease and disability, which in turn can help reduce medical costs. According to a 2016 study, a focus on preventive healthcare can significantly reduce medical costs and improve the quality of healthcare services.

What to Expect During a Wellness Visit

A wellness visit may be performed by a healthcare provider such as a doctor, nurse practitioner, clinical nurse specialist, physician assistant, or other qualified health professional.

These are some of the steps a wellness visit may involve:

• Family history: Your healthcare provider may ask you detailed questions about your family’s medical history, to determine whether you are at an increased risk for certain health conditions that may be passed on genetically .
• Medical history: You may also be asked questions about your personal medical history. It can include information about any current or previous diseases, allergies, illnesses, surgeries, accidents, medications, vaccinations, and hospitalizations, as well as the results of any medical tests and examinations.
• Measurements: Your healthcare provider may measure your height, weight, heart rate, blood pressure, and other vital signs. Doing this regularly can help you establish a baseline as well as track any changes in your health.
• Cognitive assessment: Your healthcare provider may assess your ability to think, remember, learn, and concentrate, in order to screen for conditions such as Alzhemer’s disease and dementia.
• Mental health assessment: Your healthcare provider may also assess your mental health and state of mind, to help screen for conditions such as depression and other mood disorders.
• Physical assessment: Your healthcare provider may perform a physical examination to check your reflexes. They may also perform a neurological exam, a head and neck exam, an abdominal exam, or a lung exam.
• Functional assessment: Your healthcare provider may assess your hearing, your vision, your ability to perform day-to-day tasks, your risk of falling, and the safety of your home environment.
• Lifestyle factors: Your healthcare provider may ask you questions about your nutrition, fitness, daily habits, work, stress levels, and consumption of substances such as tobacco, nicotine, alcohol, and drugs.
• Health risk assessment: Based on this information, your healthcare provider will evaluate your health, and determine whether you are at an increased risk for any health conditions.
• Health advice: Your healthcare provider may advise you on steps you can take to improve your health, control risk factors, and prevent disease and disability. This may include nutrition counseling, an exercise plan, flu shot and vaccination recommendations, and fall prevention strategies, among other things.
• Screenings: Your healthcare provider may recommend that you get screened for certain health conditions such as depression , cholesterol, blood pressure, diabetes, cancer, heart disease, or liver conditions. This may involve blood work, imaging scans, or other screening tests. 
• Medication review: Your healthcare provider may review your medication and adjust it, if required. This can include prescription medication, over-the-counter medication, vitamins, supplements, and herbal or traditional medication.
• Referrals and resources: If required, your healthcare provider will provide a referral to other healthcare specialists. They can also provide other resources that may be helpful, such as counseling services or support groups , for instance.
• Medical providers: Your healthcare provider will work with you to create or update a list of your current medical providers and equipment suppliers. This list can be helpful in case of an emergency.
• Healthcare plan: Your healthcare provider will work with you to create a healthcare plan that is tailored to your needs. The plan will serve as a checklist that will list any screenings or preventive measures you need to take over the next five to 10 years.

The screenings, assessments, and healthcare plan can vary depending on factors such as your age, gender, lifestyle, and risk factors.

How to Prepare for a Wellness Visit

These are some steps that can help you prepare for a wellness visit:

• Fill out any required questionnaires: Your healthcare provider may ask you to fill out a questionnaire before your visit. The questionnaire may include some of the factors listed above. Make sure you do it before your visit, so that you can make the most of your time with your healthcare provider.
• Carry your medications: If possible, try to carry your medications with you to show them to your healthcare provider.
• Take your medical documents along: It can be helpful to carry your prescriptions, immunization records, as well as the results of any medical tests or screenings you have had, to help give your healthcare provider a more accurate picture of your health status.
• Ask someone to go with you: You may want to take a trusted friend or family member along with you for the wellness visit. They can assist you if required, take notes for you, ask questions, and help you remember your healthcare provider’s instructions.
• Note down questions and concerns: A wellness visit is a good opportunity to ask your healthcare provider any questions you have about your health and tell them about any health problems or concerns you have. Making a list and carrying it with you to the visit can help ensure that you don’t miss anything.
• Check your insurance plan: Most insurance plans cover wellness visits; however, what is covered as part of the wellness visit can vary depending on the plan. It can be helpful to know what preventative services and wellness visits your plan offers. It’s important to check that your healthcare provider takes your insurance and to inform them that you’ll be coming for a wellness visit when you schedule your appointment.

A Word From Verywell

A wellness visit can help you evaluate your health status, understand your risk for specific health conditions, and give you the information and resources you need to improve your health.

After you go for a wellness visit, it’s important that you start implementing your healthcare provider’s advice, take any follow-up appointments necessary, and take steps to improve your health.

U.S. Department of Health and Human Services. Get your wellness visit every year .

University Hospitals. What you need to know about wellness visits .

Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General health checks in adult primary care: a review . JAMA . 2021;325(22):2294-2306. doi:10.1001/jama.2021.6524

Musich S, Wang S, Hawkins K, Klemes A. The impact of personalized preventive care on health care quality, utilization, and expenditures . Popul Health Manag . 2016;19(6):389-397. doi:10.1089/pop.2015.0171

Alzheimer’s Association. Annual wellness visit .

University of Michigan Health. Your yearly wellness visit .

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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What’s Included in a Wellness Exam?

Regular meetings with your primary care doctor or primary care physician are important to ensure good health and wellness. Many people think that if they are healthy, they can skip the annual wellness visit, but this isn’t the case. If your health is important to you, wellness exams should be too.

What are wellness exams?

A wellness exam is a type of preventative care. Preventative healthcare focuses on maintaining wellness and stopping health problems before they occur. Instead of waiting until you have a health issue, you visit your physician to make sure that you’re still in good health, or to catch health problems in early stages.

Wellness visits or wellness exams  are typically annual, and are separate from other medical visits related to illness or injury.

While wellness exams are usually covered by insurance, your insurance might not cover all expenses involved with the visit, such as labs or tests. Most insurance plans pay for one wellness exam each year, so be sure to take advantage of this. Insurance plans and coverage vary, so be sure to check with your policy.

What is included in a wellness exam?

Wellness visits basically provide your doctor with a status update on your overall health. They can help guide you to make choices that promote better health, and they can catch health problems early.

These visits may include:

• A physical examination
• Checking your vitals
• Checking BMI
• Examination of personal and family medical histories
• Discussion of current lifestyle and health choices
• Shots and immunizations
• Establishing a plan for your health

Screenings may vary depending on age, risk, and gender. During your wellness exam you may receive screening for cholesterol, blood pressure, diabetes, mammogram, pap test, osteoporosis, or STDs.

Your doctor may ask you about current stress, physical activity, diet, or drug use such as tobacco and alcohol. Much of the exam is discussion about ways to improve overall health through lifestyle and healthy decision making. Be frank in your answers — full information helps you and your doctor work together for the best outcome.

Schedule your wellness exam today!

It’s important to tell your doctor about any health questions, concerns, or problems during your wellness visit. Starting a dialogue about your health greatly improves the quality of your healthcare. Be sure to write down any questions you have for your physician before your visit.

Annual wellness visits are essential to maintaining good health and with most insurance plans, they are covered 100% with no copays. Check with your plan for how often you qualify for a wellness visit. Schedule your wellness exam with a MANA physician today!

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What Does a Medicare Wellness Visit Include?

Routine medical care is important when you’re sick or suffering from an ailment, but what about when you’re feeling fine? The truth is, scheduling an annual doctor’s visit to assess your health, often referred to as a wellness visit, is just as important to do when you’re feeling fine as it is when you’re feeling under the weather. These visits provide your physician the chance to discuss any healthcare concerns you may have, and they also give you the opportunity to ask questions about any medications or supplements you’re taking or about changes to your diet or exercise routine.

The Difference Between a Physical and a Wellness Visit

For many people, the terms “physical” and wellness visit” are used interchangeably, but they are actually quite different. During a physical, your doctor carries out a physical exam of your major systems, takes measurements, documents any changes and reviews concerns. During a wellness visit, there is typically no examination that takes place other than a general inspection of the body. A wellness visit is more like checking in with your doctor while a physical is more like an in-depth examination to assess body systems and functions. During a wellness visit, you may bring up a medical concern which prompts a physical exam, and during a physical, you may discuss wellness concerns, but the two are billed as separate types of visits.

Fortunately for Medicare recipients, an annual wellness visit is included with Part B coverage. During a wellness visit under Medicare, patients will have the chance to discuss any changes to existing conditions that have previously been documented, and the physician will review medical history to ensure that the patient is still in need of any prescribed medications. A doctor may also provide the patient with a preventive health plan designed to encourage healthy lifestyle choices. This plan may detail dietary changes or weight loss exercises, smoking or alcohol cessation information, a list of support groups or therapeutic care providers and more.

While wellness visits usually do not include any type of treatment in the doctor’s office unless an emergency occurs, patients are often directed to make a follow-up appointment for further screening if the wellness visit brings to light concerns that need to be addressed in detail. Keep in mind that this follow-up visit will not be covered as a wellness visit under Medicare and will be billed as a regular outpatient visit.

Additionally, a cognitive assessment is typically performed during the wellness visit, but this is usually done simply by conversing in the office. Finally, patients will fill out a wellness questionnaire while waiting to see the doctor, and the answers will be assessed to ensure that the doctor is able to address any symptoms that are deemed problematic that may not have been expressed directly by the patient.

Medicare Coverage Beyond Wellness Visits

If further medical treatment is required subsequent to a wellness visit, the good news is that Medicare provides a range of coverage options in the forms of inpatient, outpatient and prescription drug benefits. Medicare Part A covers things like inpatient hospitalization and skilled nursing care, and Medicare Part B provides coverage for outpatient care when it comes to doctor’s visits and treatments at clinics or testing at a lab. Medicare Part D is the prescription drug benefit and covers most medications that can be purchased at a retail pharmacy to be administered at home.

If you’re unsure as to your benefits or you’re considering Medicare in the future and would like to know more about your options, contact your current plan and/or research your options to find the Medicare coverage that will meet your needs.

Related articles:

Retiring under the age of 65? Understanding Your Medicare Benefits (Opens in a new browser tab)

Do Medicare Advantage Plans Cover Wellness Exams? (Opens in a new browser tab)

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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

• You have had Part B for over 12 months
• And, you have not received an AWV in the past 12 months

Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.

Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
• Learn about your medical and family history
• Medications include prescription medications, as well as vitamins and supplements you may take
• Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
• Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
• Screen for depression
• Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.

AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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What to Expect at Your Annual Wellness Visit

Once a year, you make an appointment with your primary care physician to make sure your health is in good working order and detect potential concerns early, before symptoms are noticeable.

To schedule your annual wellness or follow-up office visit with a provider in Primary Care, please visit here or login to Connect .

Most insurance plans cover your annual wellness exam — no copay required. However, you may find the actual components of a wellness visit a bit confusing.

Review the FAQs below to learn what to expect during your next annual wellness visit.

Frequently Asked Questions

What is included in a wellness visit.

Your annual wellness visit includes the following:

• A review of your medical and surgical history
• Screenings - we generally follow screening recommendations of the USPSTF
• Blood tests
• Immunizations - we follow the vaccine schedules published by the CDC
• A physical exam
• Counseling to prevent future health problems 

How should I prepare for my visit?

Please check in via Connect up to 5 days before your visit to make sure we have your most up-to-date information, including your medications, medical history and insurance. You will be able to update these, along with your preferred pharmacy. You can also review and update your responses to your health questionnaire.

Please fast for at least 4 hours prior to your visit. You may drink water or black coffee, and take your maintenance medications.  Pediatric and Gynecology patients should not fast.

On the day of your appointment, please arrive on time and bring your insurance card and ID.

What if I need to ask my doctor about a specific medical issue?

Specific issues are considered part of a follow-up or “sick” visit. These aspects of your visit will be billed to your insurance, and you may be responsible for copayments, coinsurance or deductible payments, based on the terms of your policy.

If you would like to address non-routine concerns during your wellness visit, you can let your doctor know about these issues when you schedule your appointment. Depending on their complexity, the questions may need to be dealt with at a later time.

What does a follow-up or “sick” visit include?

• Treatment of a chronic condition such as diabetes, asthma or high blood pressure
• Any new problems or complaints
• Your need for new medications or tests
• Referrals to a specialist
• Additional treatment options

What is a Medicare annual wellness visit and what does it include?

The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.

Your Medicare wellness visit does not include a detailed physical exam or management of chronic or new medical problems . Your physician may be able to perform a complete physical and address new or existing medical issues during your Medicare annual wellness visit, but you could incur additional charges.

What to expect during your Medicare annual wellness visit

At your Medicare annual wellness visit, your health care provider will:

• Review your blood pressure, heart rate, height, weight and body mass index (BMI).
• Review your current health problems, as well as your medical, surgical, family and social histories.
• Review your current medications.
• Conduct a health risk assessment.
• Provide nutrition counseling.
• Discuss an exercise plan to fit your lifestyle.
• Discuss smoking cessation and arrange for counseling, if needed.
• Discuss fall prevention.
• Discuss advance care planning.
• Discuss preventive screenings recommended by evidence-based practice guidelines that are indicated for you based upon your age, risk factors and family history

How to prepare for your Medicare wellness visit

Bring these items to your visit:

• Immunization records
• A list of current prescribed medicines, supplements and over-the-counter medications
• A list of your patient care team—any specialists you see for various types of care
• Be prepared to review your family medical history.

Can I combine a Medicare or non-Medicare wellness visit with a follow up visit?

Combining a wellness visit with a follow-up office visit will save you time by eliminating an extra appointment, but doing so may affect your costs. Additional concerns beyond a wellness visit may be billed to your insurance, which can  result in unplanned out-of-pocket costs to you. For these reasons, Weill Cornell Primary Care recommends that you schedule your annual wellness visit and any follow-up or sick office visits separately.

What are the most important points I need to keep in mind?

• Review your insurance plan’s summary of benefits before your appointment to understand what your insurance company will or will not cover.
• When scheduling a wellness visit, clearly state that you would like to make an appointment for your annual wellness or preventive care exam. That will help the practice prepare for your visit and bill your insurance company appropriately.
• When you speak with your doctor or other practitioner, let them know you are there for a wellness exam. Or, if you need to discuss a specific concern that may require treatment, make sure to bring their attention to any non-routine concerns at the start of your appointment.

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Well Visits vs. Sick Visits – Know the Difference

Published on Jan 11, 2024

Primary Care Locations

Thank you for trusting Children’s Hospital of Philadelphia (CHOP) with your child’s care. We know there’s often confusion about the different types of visits we offer and how they are billed. Even if your insurance plan covers your visit to CHOP, you may be responsible for cost-sharing expenses, such as co-pays, co-insurance and deductibles. We hope the information below is helpful.

What is included in a well visit?

A preventive visit — also called a well visit — is a scheduled check-up focused on keeping your child's whole body healthy and safe. These checkups are recommended for infants, children and teens. Kids need one preventive visit every year from age 3 through age 21; babies and young toddlers need them more frequently. These appointments can include preventive care like: 

• A general physical exam – This includes measuring height, weight and blood pressure, and other age-specific growth and development checks.
• Age-specific immunizations (vaccinations) such as chicken-pox, measles, whooping cough, hepatitis, etc.
• Age-specific screenings, such as hearing and vision screenings.

These visits are typically covered by your health insurance, often at no cost to you. Some of the specific tools used during screenings may be billed separately.

What is a sick (office) visit?

This type of visit is made when your child is having a specific health problem, illness or injury, or for management of chronic, ongoing health problems and/or medications. Reasons for this type of visit can include:

• Illness such as the flu, strep throat or an ear infection
• Anxiety/depression
• ADHD management
• Other chronic condition

There is usually a cost for this type of visit. Your insurance provider may pass some or all of the costs to you. You may be responsible for a copay, co-insurance or deductible.

Can I be charged for both types of visits?

Sometimes at a well visit, an issue comes up that's not part of the regular check-up but that needs to be addressed during that visit. Your provider could address a problem to manage a condition or illness and may prescribe medication, order additional tests like lab work or X-rays, or refer you to a specialist.

In these cases, insurance requires us to bill the visit as both a well visit and a sick (office) visit, so you will likely have to pay an additional co-pay or co-insurance, or the cost will be applied to your deductible.

For more information

See a list of insurance plans CHOP accepts.

Medicare Wellness Visits Back to MLN Print November 2023 Updates

What’s Changed?

• Added information about monthly chronic pain management and treatment services
• Added information about checking for cognitive impairment during annual wellness visits
• Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

• Health Equity Technical Assistance Program
• Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

• Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
• Current medications, supplements, and other substances the person may be using
• Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
• Physical activities
• Social activities and engagement
• Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

• Current or past experiences with depression
• Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

• Ability to perform activities of daily living (ADLs)
• Hearing impairment
• Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
• Visual acuity screen
• Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

• Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
• If you agree to follow their advance directive
• This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

• Review any potential opioid use disorder (OUD) risk factors
• Evaluate their pain severity and current treatment plan
• Provide information about non-opiod treatment options
• Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

• A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
• Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

• Physician (doctor of medicine or osteopathy)
• Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

• 42 CFR 410.16
• Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
• Section 80 of the Medicare Claims Processing Manual, Chapter 18
• U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

• You or the patient can update the HRA before or during the AWV
• Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
• Demographic data
• Health status self-assessment
• Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
• Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
• Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

• Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
• Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
• Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

• Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

• Checklist for the next 5–10 years
• United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
• Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

• A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
• Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
• IPPE risk factors or identified conditions
• Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

• Fall prevention
• Physical activity
• Tobacco-use cessation
• Social engagement
• Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

• Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
• Future care decisions they might need or want to make
• How they can let others know about their care preferences
• Caregiver identification
• Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

• Review any potential OUD risk factors
• Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

• Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

• Mental health conditions, including depression, substance use disorders , and cognitive impairments
• Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

• Medical records, including immunization records
• Detailed family health history
• Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
• Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

• Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

• Provided on the same day as the covered AWV
• Provided by the same provider as the covered AWV
• Billed with modifier 33 (Preventive Service)
• Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

• 42 CFR 410.15
• Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

• We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
• We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

• We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
• We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
• We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

• We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
• Patients pay 100% out of pocket

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CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Common questions about Medicare annual wellness visits

If you are a Medicare recipient, you can take advantage of annual wellness visits. These visits are a preventive health benefit available after having Medicare Part B coverage for at least one year. All Medicare Advantage Plans are required to offer annual wellness visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs.

In most cases, the annual wellness visit will be followed by a separate medical visit  with your primary care professional to close any health care gaps and address any problems identified during the visit.

Here are answers to common questions about annual wellness visits.

Why are annual wellness visits important.

The annual wellness visit allows you to review your health history and identify any current or potential health risks with a health care professional. The visit enables the nurse to focus on prevention and wellness while making sure you are current on recommended immunizations and health screenings like colonoscopies or mammograms. It also allows your primary care professional more time to focus on your medical concerns and needs at a separate physical exam.

Do I need to be 65 or older to have an annual wellness visit?

You do not need to be 65 or older to qualify for an annual wellness visit as long as you've been on Medicare Part B for at least one year.

How is an annual wellness visit scheduled?

If you are due for an annual wellness visit, you may be prompted to self-schedule the visit in the patient portal . You also may call your care team and ask to be scheduled.

If your visit is with a nurse or nurse practitioner, it's recommended to schedule this visit before the visit with your primary care professional. This allows your primary care professional the chance to address any concerns mentioned during your annual wellness visit.

How can I prepare for my annual wellness visit?

You may be asked to complete some questionnaires before arriving for your appointment, which will be sent to your patient portal account. If you cannot access the questionnaires before the appointment, plan to arrive at your appointment early to complete them.

It's helpful to come prepared to your visit with this information:

• All medications, vitamins and supplements you take, including how much and how often you take them
• Additional medical records, including immunization records
• Dates of your most recent preventive services, like a colonoscopy or mammogram, if completed by another health care facility
• Family health history, with as much detail as possible
• List of medical providers and suppliers who provide you care, equipment or services

What can you expect during an annual wellness visit?

During the visit, you'll meet with a nurse or nurse practitioner to:.

• Evaluate your fall risk
• Measure your height, weight and blood pressure
• Offer referrals to other health education or preventive services
• Provide information related to voluntary advance care planning
• Screen for cognitive impairments like dementia
• Screen for depression
• Update your medical and family history

What is the cost of an annual wellness visit?

Medicare offers the visit at no cost for people who have Medicare Part B coverage for at least one year before the visit. If you are referred for other tests or services, they will be billed to your insurance. If you have a separate visit with your primary care professional following your annual wellness visit, you or your insurance carrier will be responsible for the cost of that visit.

Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.

Related Posts

Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning .

Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

Related resources

• Preventive visits
• Social determinants of health risk assessment

Is my test, item, or service covered?

What is an Annual Wellness Visit and Why is it Important?

by Charles Smith, RN, BSN

Annual Wellness Visit

If you or your loved one are 65 years or older,  you may have heard about Medicare’s free benefit called the Annual Wellness Visit.  Here are some things you need to know and what to expect during your Annual Wellness Visit:

What is the Annual Wellness Visit?

The Annual Wellness Visit is NOT a physical. Rather, it is conversation between you and your doctor to discuss your health history and any concerns you may have regarding your health, and to review your medications and immunizations. It also is a time when you and your doctor review your existing health problems; determine what health issues may become a concern in the future and how to prevent them.

The goals of an Annual Wellness Visit are to create a complete personal and family health history and to help prevent future health problems.

What to Bring to Your Annual Wellness Visit

• A list of all of your medications, including vitamins and supplements
• Names of all of your healthcare providers, including doctors, pharmacists, therapists, home health agencies, and non-traditional providers
• Your immunization records, including flu or pneumonia shots

HIPPA laws prevent physicians from sharing information about you with one another without your permission. This is why it is important to bring this information with you to your Annual Wellness Visit, particularly if you see multiple healthcare providers.

What to Expect

The Annual Wellness Visit is performed either by your physician, a nurse or a nurse practitioner. You can expect your provider to discuss with you your health history, medications, healthcare team and immunization schedule. Other components of the Annual Wellness Visit are a Health Risk Assessment, a Wellness Schedule, Advance Directives and a Personal Health Record.

Your Health History

The AWV begins with your doctor collecting your family and personal health history. Your physician may have most of this information, but it is important to provide information that is not in your records to ensure that your health history is correct and complete.

Medication Review

Your doctor will review your list of medications, including those prescribed by other physicians, to ensure that there are no negative interactions. This is a good time to ask questions you may have about your medications.

Your Healthcare Team

Your provider will create a comprehensive list of your healthcare team for future reference.

Immunization Schedule

Your doctor will review your immunizations and determine if you need additional vaccines.

Health Risk Assessment

A Health Risk Assessment includes your weight, height and blood pressure. You will be asked such questions as your ability to care for yourself, your memory, whether or not you are depressed, and your smoking and drinking habits.The purpose is to determine if you are at risk for future illnesses. Once the Health Risk Assessment is completed, your doctor may recommend screenings in the event some concerns arose during the assessment. These screenings will be performed during a separate visit, and possibly with another physician, depending on the type of screening. Your doctor is required to tell you if the screening requires a co-pay.

The Wellness Schedule

Medicare requires physicians to provide a Wellness Schedule to patients during the Annual Wellness Visit. The Wellness Schedule is a list of all of the screenings you should have during the next five-to-10 years. These screenings can include prostate exams, mammograms and heart-related screenings. Many of these are free to the patient.

Advance Directives

While physicians are no longer required to give their patients information on Advance Directives – or Living Wills – you can discuss your wishes with your doctor and ask about the procedures you need to follow to complete an Advance Directive. Your physician should be able to provide a standard form for you to complete.

Personal Health Record

All of the information collected during your Annual Wellness Visit is compiled into one document called a Personal Health Record. You can obtain a copy of your Personal Health Record from your physician. It is a great tool to use when you have to go to the hospital, see other doctors, or visit small clinics. Since healthcare providers are not allowed to discuss your health situation with other providers, the Personal Health Record helps ensure that all of your healthcare providers have your complete health history.

It also can be very helpful to your adult children to have a copy of your Personal Health Record in the event they need to represent you at the hospital or emergency room.

Be Your Own Advocate

The Annual Wellness Visit gives you and your doctor a complete picture of your health and what you need to do to be healthier. The more you know about your health, the more likely you are to be your own advocate. So, schedule your Annual Wellness Visit, have a great conversation with your doctor and stay healthy.

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Well-baby and well-child visits

Well-Woman Visits

(gynecologic preventive care).

• Pelvic Examination |
• Breast Examination |
• Psychosocial Screening and Counseling |

Periodic well-woman visits may be provided by a gynecologist, other women's health clinician, or primary care clinician.

Recommendations vary regarding the frequency of primary care or gynecologic preventive care visits. The American College of Obstetricians and Gynecologists (ACOG) recommends well-woman visits every year for all women who are sexually active or > 18 years. The ACOG recommends that these visits include screening, evaluation, counseling, and immunizations based on age and risk factors.

Well-woman visits should include taking a comprehensive medical history, including current symptoms or concerns as well as medical, surgical, gynecologic , obstetric, family, and social history, as well as medications and allergies. Although these visits are typically called "well-woman" visits, taking a gynecologic history may also be relevant for patients who are gender diverse ( 1 ).

During a well-woman visit, patients may be screened for or counseled about

Breast cancer

Cervical cancer

Sexually transmitted infections

Contraception

Preconception care

Perimenopause and menopause

Depending on history of vaccination for human papillomavirus (HPV) and age of the patient, HPV vaccination should be offered. People who are not infected with human immunodeficiency virus (HIV) but are at high risk (eg, having a partner who is living with HIV, high-risk sexual behaviors, or illicit injection drug use) should be counseled about and offered preexposure prophylaxis with antiretrovirals (PrEP) , if appropriate ( 2 ).

General health screening and counseling, such as for diabetes , hypertension , or dyslipidemia and other topics, and to encourage a healthy diet and physical activity, are addressed as part of a well-woman visit by primary care clinicians and some gynecologists.

Pelvic Examination

The decision to perform a pelvic examination should be a shared decision between the patient and clinician ( 3 ). Pelvic examinations may be performed if indicated based on symptoms, as part of routine preventive care screening, or if a woman expresses a preference for the examination after reviewing the risks and benefits. There are inadequate data to support recommendations for or against performing a routine screening pelvic examination among asymptomatic nonpregnant patients who are not at increased risk of any specific gynecologic disease (eg, ovarian cancer, uterine cancer) ( 4 ). Also, pelvic examination is not indicated for initiation or renewal of contraception, except for an intrauterine device .

Women with risk factors for gynecologic cancer (eg, history of cervical dysplasia, in-utero exposure to diethylstilbestrol [DES], or prior gynecologic malignancy) may require more frequent screening and should be managed according to current guidelines.

Breast Examination

Like the pelvic examination, the decision to perform a breast examination should be a shared decision between the patient and clinician and performed when indicated by medical history or symptoms or if the patient expresses a preference for the examination ( 5 ).

Psychosocial Screening and Counseling

Assessment and counseling should be provided regarding

Intimate partner violence

Mental health

Substance use, including alcohol misuse and smoking cessation

All patients should be asked about domestic violence, including intimate partner violence , at their initial primary care or gynecologic or obstetric visit (and again at regular intervals) ( 6 ). Methods include self-administered questionnaires and a directed interview by a clinician. In patients who do not report they are experiencing abuse, findings that suggest current or past abuse include the following:

Frequent emergency department visits

Delay in seeking treatment for injuries

Inconsistent explanations for injuries

Head and neck injuries

Chronic unexplained abdominal pain or headaches

Psychiatric symptoms

Frequent sexually transmitted infections

Prior delivery of a low-birth-weight infant ( 7 )

Older adults with evidence of neglect or physical injury

1. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice : Opinion No. 823: Health care for transgender and gender diverse individuals. Obstet Gynecol 137 (3):e75–e88, 2021. doi: 10.1097/AOG.0000000000004294

2. American College of Obstetricians and Gynecologists  (ACOG) : ACOG Practice Advisory: Preexposure Prophylaxis for the Prevention of Human Immunodeficiency Virus, June 2022

3. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice : Opinion No. 754: The utility of and indications for routine pelvic examination. Obstet Gynecol 132 (4):e174–e180, 2018 (reaffirmed 2020). doi: 10.1097/AOG.0000000000002895

4. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al : Gynecological Conditions: Periodic Screening With the Pelvic Examination. March, 2017

5. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice : Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average-Risk Women.  Obstet Gynecol . 2017 (reaffirmed 2021);130(1):e1-e16. doi:10.1097/AOG.0000000000002158

6. Feltner C, Wallace I, Berkman N, et al . Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Oct. (Evidence Synthesis, No. 169.) Appendix F Table 1, IPV Screening Instruments. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533715/table/appf.tab1/

7. Laelago T, Belachew T, Tamrat M . Effect of intimate partner violence on birth outcomes.  Afr Health Sci . 2017;17(3):681-689. doi:10.4314/ahs.v17i3.10

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Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

• Vaccines & Immunizations

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Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

• HEDIS Measures and Technical Resources
• Child and Adolescent Well-Care Visits

Child and Adolescent Well-Care Visits (W30, WCV)

Well-Child Visits in the First 30 Months of Life : Assesses children who turned 15 months old during the measurement year and had at least six well-child visits with a primary care physician during their first 15 months of life. Assesses children who turned 30 months old during the measurement year and had at least two well-child visits with a primary care physician in the last 15 months.

Child and Adolescent Well-Care Visits: Assesses members 3–21 years of age who received one or more well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

Why It Matters?

Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. 1 Well-care visits provide an opportunity for providers to influence health and development and they are a critical opportunity for screening and counseling. 2

Results – National Averages

Well child visits in the first 15 months, well child visits in the first 30 months of life (15 months – 30 months), well-child visits (ages 3-6 years): 1 or more well-child visits, child and adolescent well-care visits (total):.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via  my.ncqa.org  for analysis that accounts for trend breaks.

• Bright Futures. 2021. https://brightfutures.aap.org/
• Lipkin, Paul H., Michelle M. Macias, Section on Developmental and Behavioral Pediatrics Council on Children with Disabilities, Kenneth W. Norwood Jr, Timothy J. Brei, Lynn F. Davidson, Beth Ellen Davis, et al. 2020. “Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.” Pediatrics 145 (1): e20193449. https://doi.org/10.1542/peds.2019-3449

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The benefits of well-child visits