wellness visit example

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2023 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

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.

Jose Luis Pelaez / Getty Images

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.

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

View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure .

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

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.

Medicare Interactive Medicare answers at your fingertips -->

Annual wellness visit, preventive services.

You must be logged in to bookmark pages.

Email Address * Required

Password * Required

Lost your password?

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.

Update your browser to view this website correctly. Update my browser now

The Complete Guide to the Annual Wellness Visit

This blog features a full breakdown of Medicare’s Annual Wellness Visit. Understand the AWV’s importance, get the necessary billing codes, and walk through the visit itself, step by step. 

Annual Wellness Visit Table of Contents

• Quick What is the AWV?

Why the Annual Wellness Visit Matters

• Breaking down the AWV

The AWV and the HRA

Preparing eligible medicare patients for the awv.

• 13 Initial AWV Components
• 12 Components to the Subsequent AWV 
• AWV Coding, Diagnosis, & Billing

Advance Care Planning (ACP) is an Optional Annual Wellness Visit Element

Annual wellness visit faqs, additional resources, quick, what is the annual wellness visit (awv).

It’s a visit to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA). 

As a health care provider, you may recommend patients get services more often than Medicare covers, including the AWV, or you may recommend services Medicare doesn’t cover. If this happens, please ensure patients understand they may pay some or all the cost. Communication is key to making sure patients understand why you’re recommending certain services, and whether Medicare pays for them.

What’s Covered?

• The AWA is covered once every 12 months
• The patient will pay nothing, as long as the provider accepts the assignment

The Annual Wellness Visit is different than a typical physical exam or other preventative care visits. This visit or exam expands more upon a patient’s emotional and psychological well-being, the physical portion is optional. It is an opportunity to improve the patient’s quality of care, engage the patient, and optimize payment opportunities. After the visit, providers can use the collected information to analyze risk factors, recommend appropriate preventative services, and most importantly create a unique prevention plan.

For many providers, it might be a good time to consider telehealth as a way to enrich patient care coordination and further engage patients.

Breaking Down the Annual Wellness Visit

First, your primary care doctor will ask you to fill out a questionnaire called a Health Risk Assessment that evaluates your health status, frailty and physical functioning.

It also assesses other aspects of your health, such as:

• Psychosocial risks (e.g., depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue)
• Behavioral risks (e.g.,  tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety and home safety)
• Activities of daily living (e.g., dressing, feeding, toileting, bathing, grooming, physical ambulation including balance and your risk of falls)

After reviewing this assessment, your primary care doctor will likely provide a  variety of other services  and talk to you about preventable health diseases.

Mebs Counseling Increases 100+ Encounters In One Week Using Telehealth

Mebs Counseling is unique in that most of their services and support are provided outside of the clinic. They work across schools, institutions, and off-site centers, often through a team approach that engages multiple caregivers for a single patient. While many of these sessions are conducted in person, Mebs Counseling needed a way to help ease connections between patients and caregivers through a remote care option like Azalea Health’s telehealth.

The AWV includes an HRA. See the summary below of the minimum elements in the HRA. Get more information in the  CDC’s booklet , including:

• A Framework for Patient-Centered Health Risk Assessments 
• Evidence suggests HRA use and follow-up interventions can positively influence health behaviors
• Definition of the HRA framework and rationale for its use
• Guidance on HRA use, reduction of health disparities, and improving health outcomes through identifying modifiable health risks and providing behavior change interventions

What is the HRA?

The Health Risk Assessment is another screening tool that helps patients and doctors identify patient health risks and monitors their health status over time. Similar to the  IPPE  and AWV, it seeks to prevent future health risks and complications. 

Providers can help eligible Medicare patients prepare for their AWV by encouraging them to bring the following information:

• Medical records, including immunization records
• A detailed family health history
• A full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
• A 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

13 Initial AWV Components:

This applies to the first time a patient gets an AWV

• You or the patient complete the HRA before or during the AWV; it shouldn’t take more than 20 minutes
• Demographic data
• Health status self-assessment
• Psychosocial risks include, but are not limited to depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue
• Behavioral risks include, but are not limited to tobacco use, physical activity, nutrition, and oral health, alcohol consumption, sexual health, motor vehicle (for example, seat belt use), and home safety
• Activities of Daily Living (ADLs) including dressing, feeding, toileting, grooming, physical ambulation including balance/risk of falls and bathing; and Instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, mode of transportation, shopping, managing medications, and handling finances
• Medical events of the patient’s parents, siblings, and children including hereditary conditions that place them at increased risk
• Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments
• Use of, or exposure to, medications and supplements, including calcium and vitamins
• Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.
• Body Mass Index (BMI) (or waist circumference, if appropriate)
• Blood pressure
• Other routine measurements deemed appropriate based on medical and family history
• Assess cognitive function by direct observation, considering information from the patient, family, friends, caregivers, and others.
• Consider using a brief cognitive test, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk.
• Find more information on the National Institute on Aging’s  Website.
• Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. Find more information on depression screening on the  Depression Assessments Instruments Website . 
• Ability to perform Activities of Daily Living (ADLs)
• Hearing impairment
• Home safety
• Patient’s HRA, health status and screening history, and age-appropriate preventive services Medicare covers
• The  United States Preventative Services Task Force  and  Advisory Committee on Immunization Practices
• Mental health conditions including depression, and cognitive impairment substance use disorder(s) (https://www.samhsa.gov/find-help/disorders)
• IPPE  risk factors or conditions identified
• Treatment options and associated risks and benefits
• Fall prevention
• Physical activity
• Tobacco-use cessation
• Weight loss
• Their preparation of an advance directive in case an injury or illness prevents them from making health care decisions
• Future care decisions they might need to make
• How they can let others know about care preferences
• Caregiver identification
• Explanation of advance directives, which may involve completing standard forms
• Note: “Advance directive” is a general term referring to various documents such as 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 and/or records a person’s wishes about their medical treatment used at a future time when the individual is unable to speak for themselves.
• Review their potential Opioid Use Disorder (OUD) risk factors
• Evaluate their pain severity and current treatment plan
• Provide information on non-opioid treatment options
• Refer to a specialist, as appropriate
• Get more information on pain management in this  report.
• Review the patient’s potential risk factors for SUDs and, as appropriate, refer them for treatment. A screening tool isn’t required but you may use one.
• Find more information in this  screening chart

The Complete Guide to Selecting and EHR Vendor

The EHR vendor selection process is no small task. An EHR system is a significant expense and most EHR vendors have a long onboarding and data migration process that could interrupt your day-to-day workflow. And that’s to say nothing of the fact that your business and patients are depending on a reliable, user-friendly system with accurate data. Current EHRs are not able to keep up and provide the level support needed to ensure quality care. As a result—and not surprisingly—many are reconsidering their EHR vendors.

12 Components to the Subsequent Annual Wellness Visit

• You or the patient can update the HRA before or during the AWV; it shouldn’t take more than 20 minutes
• Psychosocial risks including but not limited to depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue
• Behavioral risks including but not limited to tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle (for example, seat belt use), and home safety
• 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
• Assess cognitive function by direct observation, considering information from the patient, family, friends, caregivers, and others. Consider using a brief cognitive test, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Find more information on this website.  
• The United States Preventative Task Force and Advisory Committee on Immunization Practices
• Mental health conditions including depression, substance abuse, and cognitive impairment
• Risk factors or conditions identified
• Physical Activity
• “Advance directive” is a general term referring to various documents such as 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 and/or records a person’s wishes about their medical treatment used at a future time when the individual is unable to speak for themselves. 
• Evaluate their severity of pain and current treatment plan

AWV Coding, Diagnosis, & Billing

Use these HCPCS codes to file AWV claims:

AWV HCPCS Codes and Descriptors

G0438  – Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

G0439  – Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

G0468*  – 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.

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

Report a diagnosis code when submitting an AWV claim. Since Medicare doesn’t require you to document a AWV diagnosis code, you may choose any diagnosis code consistent with the patient’s exam.

Medicare Part B covers an AWV if performed by a:

• Physician (a Doctor of Medicine or Osteopathy)
• Qualified Non-Physician Practitioner (NPP) (a Physician Assistant [PA], Nurse Practitioner [NP], or Certified Clinical Nurse Specialist [CCNS])
• Medical professional (including a 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, Medicare may pay the additional service. Report the additional CPT code 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.

Remember, you must not bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. Medicare denies these claims with messages of “Benefit maximum for this time period or occurrence has been reached” and “Consult plan benefit documents/guidelines for information about restrictions for this service.” 

ACP is the face-to-face conversation between a Medicare 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 speak or make decisions about their care. At the patient’s discretion, you can provide the ACP at the time of the AWV.

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

ACP CPT Codes and Descriptors

99497-  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

99498-   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)

You must report a diagnosis code when submitting an ACP claim as an optional AWV element. Since Medicare doesn’t require you to document a specific ACP diagnosis code as an optional AWV element, you may choose any diagnosis code consistent with a patient’s exam.

Medicare waives both the ACP coinsurance and the Medicare Part B deductible when:

• 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

Medicare waives the ACP deductible and coinsurance once per year when billed with the AWV. If the AWV billed with ACP is denied for exceeding the once-per-year limit, Medicare will apply the ACP deductible and coinsurance.

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

What are the other Medicare Part B preventive services?

• Advance Care Planning (ACP) as an Optional AWV Element
• Alcohol Misuse Screening & Counseling Annual Wellness Visit (AWV)
• Bone Mass Measurements
• Cardiovascular Disease Screening Tests
• Colorectal Cancer Screening
• Counseling to Prevent Tobacco Use
• Depression Screening
• Diabetes Screening
• Diabetes Self-Management Training (DSMT)
• Flu, Pneumococcal, & Hepatitis B Shots and their Administration Glaucoma Screening
• Hepatitis B Screening
• Hepatitis C Screening
• Human Immunodeficiency Virus (HIV) Screening
• Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
• IBT for Obesity
• Initial Preventive Physical Examination (IPPE)
• Lung Cancer Screening
• Medical Nutrition Therapy (MNT)
• Medicare Diabetes Prevention Program (MDPP)
• Prolonged Preventive Services
• Prostate Cancer Screening
• Screening for Cervical Cancer with
• Human Papillomavirus (HPV) Tests
• Screening for Sexually Transmitted Infections (STIs) & High Intensity Behavioral Counseling (HIBC) to Prevent STIs
• Screening Mammography
• Screening Pap Tests
• Screening Pelvic Examination (includes a clinical breast examination)
• Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

Are clinical laboratory tests part of the IPPE or AWV?

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

Does the deductible or coinsurance/copayment apply for the AWV?

No. Medicare waives the AWV coinsurance or copayment and the Medicare Part B deductible.

Who is eligible for the AWV?

Medicare covers an AWV for all patients who aren’t within 12 months after the eligibility date for their first Medicare Part B benefit period and who didn’t have an IPPE or an AWV within the past 12 months. Medicare pays for only 1 IPPE per patient per lifetime and 1 additional AWV per year thereafter.

Can I bill an electrocardiogram (ECG/EKG) and the AWV on the same date of service?

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

How do I know if a patient already got their first AWV from another provider and whether to bill for a subsequent AWV even though this is the first AWV I provided to this patient?

You have different options for accessing AWV eligibility information depending on where you practice. You may access the information through the  Health Insurance Portability and Accountability Act  Eligibility Transaction System or through the provider call center Interactive Voice Responses (IVRs).  We suggest providers check with their MAC for available options to verify patient eligibility.

Resources for Blog

Medicare Claims Processing Manual (cms.gov)

Medicare Benefit Policy Manual (cms.gov)

The Complete Guide to the Initial Preventative Physical Exam

Top 10 Benefits to Telepsychiatry

Progessive Therapeutics: Telehealth Security Case Study

Who we serve.

• 866 - 306 - 6097
• 877-777-7686
• [email protected]

• All rights Reserved.
• Privacy Policy

Recent Posts

• Behavioral Health
• Children's Health (Pediatrics)
• Exercise and Fitness
• Heart Health
• Men's Health
• Neurosurgery
• Obstetrics and Gynecology
• Orthopedic Health
• Weight Loss and Bariatric Surgery
• Women's Health

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

• Locations FAQs Schedule Online Log-in

Select specialty you want to schedule with:

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.

Make An Appointment

Whether you see us in-person or by Video Visit, we're here for you. See how we're keeping you safe.

Schedule Online

(646) 962-8000

Doctor Visits

Get Your Medicare Wellness Visit Every Year

Take Action

If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.

What happens during a yearly wellness visit?

First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.

During your visit, the doctor or nurse will:

• Go over your health risk assessment with you
• Measure your height and weight and check your blood pressure
• Ask about your health history and conditions that run in your family 
• Ask about other doctors you see and any medicines you take
• Give advice to help you prevent disease, improve your health, and stay well
• Look for any changes in your ability to think, learn, or remember
• Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed

If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist. 

Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick. 

Learn more about yearly wellness visits .

Plan Your Visit

When can i go for a yearly wellness visit.

You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.

Do I need to have a “Welcome to Medicare” visit first?

You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.

If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit. 

Learn more about the “Welcome to Medicare” visit .

What about cost?

With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.

If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.

Who Can Get Medicare?

Medicare is a federal health insurance program. You may be able to get Medicare if you:

• Are age 65 or older
• Are under age 65 and have a disability
• Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
• Have permanent kidney failure (called end-stage renal disease)

You must be living in the United States legally for at least 5 years to qualify for Medicare.  Answer these questions to find out when you can sign up for Medicare .

Make an Appointment

Take these steps to help you get the most out of your Medicare yearly wellness visit.

Schedule your Medicare yearly wellness visit.

Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.

If you're looking for a new doctor,  check out these tips on choosing a doctor you can trust .  

To find a doctor who accepts Medicare:

• Search for a doctor on the Medicare website
• Call 1-800-MEDICARE (1-800-633-4227)
• If you use a TTY, call Medicare at 1-877-486-2048

Gather important information.

Take any medical records or information you have to the appointment. Make sure you have important information like:

• The name and phone number of a friend or relative to call if there’s an emergency
• Dates and results of checkups and screening tests
• A list of vaccines (shots) you’ve gotten and the dates you got them
• Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
• Phone numbers and addresses of other places you go to for health care, including your pharmacy

Make a list of any important changes in your life or health.

Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:

• Losing your job
• A death in the family
• A serious illness or injury
• A change in your living situation

Know your family health history.

Your family's health history is an important part of your personal health record.  Use this family health history tool  to keep track of conditions that run in your family. Take this information to your yearly wellness visit.

Ask Questions

Make a list of questions you want to ask the doctor..

This visit is a great time to ask the doctor or nurse any questions about:

• A health condition
• Changes in sleeping or eating habits
• Pain or discomfort
• Prescription medicines, over-the-counter medicines, or supplements

Some important questions include:

• Do I need to get any vaccines to protect my health?
• How can I get more physical activity?
• Am I at a healthy weight?
• Do I need to make any changes to my eating habits?

Use this question builder tool  to make a list of things to ask your doctor or nurse.

It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.

What to Expect

Know what to expect at your visit..

The doctor or nurse will ask you questions about your health and safety, like:

• Do you have stairs in your home?
• What do you do to stay active?
• Have you lost interest in doing things you usually enjoy?
• Do you have a hard time hearing people on the phone?
• What medicines, vitamins, or supplements do you take regularly?

The doctor or nurse will also do things like:

• Measure your height and weight
• Check your blood pressure
• Ask about your medical and family history

Make a wellness plan with your doctor.

During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.

Your plan may include:

• Getting important screenings for cancer or other diseases
• Making healthy changes, like getting more physical activity

Follow up after your visit.

During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.

If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.

Add any new health information to your personal health documents.

Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.

Medicare offers an online tool called  MyMedicare  to help you track your personal health information and Medicare claims. If you have your Medicare number, you can  sign up for your MyMedicare account now .

Healthy Habits

Take care of yourself all year long..

After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:

• Getting important screenings
• Getting vaccines for older adults
• Keeping your heart healthy
• Preventing type 2 diabetes
• Lowering your risk of falling

Your plan could also include:

• Getting active
• Eating healthy
• Quitting smoking
• Watching your weight

Content last updated February 9, 2023

Reviewer Information

This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services

Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group

November 2022

You may also be interested in:

Choosing a Doctor: Quick Tips

Lower Your Risk of Falling

Oral Health for Older Adults: Quick Tips

The office of disease prevention and health promotion (odphp) cannot attest to the accuracy of a non-federal website..

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

Medicare Annual Wellness Visit

Are you conducting a Medicare Annual Wellness Visit? Enhance the efficiency of this consultation with this Medicare Annual Wellness Visit Checklist.

By Priya Singh on Apr 08, 2024.

Fact Checked by Ericka Pingol.

What Is a Medicare Annual Wellness Visit Checklist?

A Medicare Annual Wellness Visit (AWV) Checklist is a comprehensive resource, effective for healthcare providers to use in their annual patient health assessments. It guides the assessment of a patient's overall health, providing a manageable step-by-step guide to 

a thorough health risk assessment (HRA) and developing personalized prevention plans (PPP). Ensuring a comprehensive HRA is imperative to identifying patient health concerns and potential risks for developing future injuries or illnesses, which can then inform an effective PPP to mitigate these risk factors and help patients achieve optimal health and well-being. 

Implementing a Medicare Annual Wellness Visit Checklist in your future, yearly patient consultations can transform your approach to patient health and wellbeing. It prompts a comprehensive assessment of a patient's current health, including measures of height, weight, blood pressure, and previous medical history. Additionally, patients have the opportunity to voice any health concerns or symptoms they have been experiencing, encouraging a collaborative relationship between patients and healthcare providers. This empowers healthcare providers to provide their patients with the greatest care while also allowing patients to be self-determined in their health. 

As a primary prevention strategy, a Medicare Annual Wellness Visit can help healthcare providers identify health concerns before they become unmanageable or impact patient’s daily activities. This can significantly reduce future healthcare costs, increase provider reimbursements, and provide time for effective interventions. Additionally, early detection of health risks can provide more treatment options, allowing patients to make more informed decisions with their loved ones and healthcare providers.

Using this checklist, healthcare providers can proactively manage their patient’s health. This ensures early detection, development of PPPs, and early intervention that provides patients with the best care to manage their health.

Downloadable Medicare Annual Wellness Visit Checklist

Check out our free Medicare Annual Wellness Visit Checklist PDF

How Does It Work?

The Medicare Annual Wellness Visit Checklist is a user-friendly tool that breaks down AWVs into manageable actions. Designed to be a guide for best practice habits, it can be adjusted to fit the needs and concerns of patients, empowering healthcare providers and patients to be proactive when it comes to their health. 

Step 1: Accessing Your Checklist

To begin, you can access the Printable Medicare Annual Wellness Visit Checklist here or download the free Medicare Annual Wellness Checklist PDF. 

Step 2: Verify Patient Eligibility

Ensure the patient’s eligibility for the Medicare Annual Wellness Visit. Communicate with patients to identify the services that Medicare covers to avoid any complications or miscommunications. This ensures Medicare compliance, protecting claim rejections, penalties, or financial burdens. 

Step 3: Communicate Requirements and Expectations

Prior to the AWV, patients should be aware that the visit is covered once every 12 months and that patients will not be required to pay contingent on providers accepting the procedure. Additionally, discuss that the purpose is to develop or update PPPs and perform HRA’s. It does not include a physical exam or diagnostic procedures. 

Step 4: Health Risk Assessment (HRA)

Prior to the AWV, encourage patients to complete a self-reported HRA either online or in the office. This may include demographic information, current health status, psychosocial risks, behavioral risks, and activities of daily living (ADLs). 

Step 5: Identify Current Medical Providers 

Create a list of the patient’s current healthcare providers, including equipment suppliers, behavioral care providers, and pharmacies. This can help you understand their current medical needs.

Step 6: Routine Measurements

During the visit, complete routine measurements of height, weight, body mass index (BMI), blood pressure, and other appropriate measurements based on the patient’s previous medical and family history. These can help track changes in patient health. 

Step 7: Cognitive Assessments

Assess cognitive functioning to detect any changes or decline, this can help identify risks of cognitive impairments and future conditions such as dementia or Alzheimer’s and maintain independence. This may involve gathering information from caregivers and loved ones. 

Step 8: Develop a PPP

After considering the information from the HRA, routine measurements and cognitive assessments, you can develop a PPP to address any concerns or risks. This could involve further screening, consultation or interventions.

Medicare Annual Wellness Visit Example (sample)

Explore the Medicare Annual Wellness Visit Checklist Example, a comprehensive, practical demonstration of how the checklist can be applied in a real AWV. Our Medicare Annual Wellness Visit Checklist PDF offers a visual reference that practitioners can use as a template to create a personalized checklist. This resource can simplify the AWV process and ensure a thorough assessment that can aid practitioners to be proactive with their patient’s health and providing optimal care solutions.  

This is just one example of how Carepatron offers practice management solutions to simplify this process and ensure best practice amongst medical personnel.

Download our free Medicare Annual Wellness Visit PDF

When Would You Use This Checklist?

The Medicare Annual Wellness Visit Checklist can be used across many contexts. It is essential during AWV procedures for Medicare beneficiaries, critical to ensure a thorough and precise assessment in accordance with the specific guidelines and requirements of Medicare. Scenarios that may benefit from this checklist include: 

• Annual Wellness Visits: Guides a thorough health assessment and yearly updates of medical records. 
• Comprehensive Medical Records: This checklist ensures a thorough assessment of wellness, meticulously tracking patient records and family medical history. These records may be beneficial in the future to develop interventions or identify health concerns, from which the healthcare provider can implement an effective PPP to mitigate risks and symptoms.
• Pediatric Wellness Exams: Enables healthcare providers to meticulously track progress and changes during the health and development of children, a crucial resource for pediatric care providers.
• Risk Assessments for Older Adults: This checklist ensures a thorough health examination, which may identify areas that may require further screening or intervention. For older individuals, this may involve proactive screening for conditions such as high blood pressure or risks of cognitive decline, where healthcare providers can begin interventions to reduce the effects or risks, beneficial to guide their transition into older age and help maintain their independence. 
• Primary Prevention: the checklist prompts early detection of health conditions and illnesses, providing individuals time to consult with their healthcare providers, caregivers, and loved ones to make informed decisions around treatment. 

This resource is applicable in scenarios requiring a comprehensive and standardized wellness assessment. It can enhance the delivery of primary interventions and proactive care by healthcare services and establish thorough records of patient medical history, which can inform future treatments and care.

What Do the Results Mean?

Conducting a Medicare Annual Wellness Visit Checklist can have a range of benefits and results across various health contexts. It is an instrumental resource that can enhance health practitioners’ approach, ensuring best practices, compliance with Medicare guidelines and requirements, and a seamless experience for Medicare beneficiaries. Though results may differ amongst medical bodies, here are some common experiences:

• Enhanced care: Our checklist breaks down the Medicare Annual Wellness Visit into simple, manageable steps that allow practitioners to conduct a thorough assessment. Conducting a meticulous assessment is essential to identifying the patient’s needs, health concerns, and risk factors involved in devising an effective PPP that enhances patient health. 
• Accurate patient records: In healthcare contexts, such as pediatric care and family general practitioner services, this checklist proves its value by not only enhancing the quality of care, but also ensuring accurate recording of developmental milestones and annual updates to patient health records. This promotes comprehensive patient management and a thorough record of individual patient wellness journeys.
• Improved communication: The checklist emphasizes a transparent collaboration between patients and healthcare providers, which allows patients to make informed decisions when it comes to their health. Furthermore, crucial steps within the checklist, such as verifying patient validity and communicating requirements and expectations, can help ensure practitioners and patients are on the same page, reducing miscommunications, unmet expectations, and protection against rejected claims. 

To enhance your practice and provide your patients with optimal care, you can access the Free Medicare Annual Wellness Visit Checklist here or download the PDF copy to use as a reference.

Why Use Carepatron as Your Medicare Annual Wellness Visit App?

As an online platform, Carepatron is the optimal Medicare Annual Wellness Visit app and software due to its seamless ability to integrate the entire process of managing wellness exams. With Carepatron, healthcare providers can effectively streamline annual wellness exam checklists into their practice, communicate effectively with their patients, and have access to online clinical documentation on one platform. Here’s why Carepatron is the optimal choice for managing Medicare Annual Wellness Visits: 

Enhance Collaboration

The app allows for the sharing and accordance of information, fostering a seamless collaboration among healthcare teams. Whether this is within a single clinical practice or across a community of global healthcare providers, Carepatron allows for coordination across teams, allowing you to put your patient first. 

Patient Engagement

With mobile accessibility, Carepatron empowers patients and those around them by providing a comprehensive guide to the Medicare Annual Wellness Exam. This ensures effective communication channels and appointment scheduling between patients and healthcare providers, strengthening the patient-provider relationship. 

Global Compliance

In accordance with worldwide security requirements, Carepatron uses secure data storage software. Patients and providers can be assured that any information held within the app or software is safe and secure. 

Ongoing Documentation

Using Carepatron as your Medicare Annual Wellness Visit app and software allows for ongoing documentation. This can help you track patient records, previous medical history, and symptoms that can help identify risks or concerns of further health concerns. Our software allows you to optimally save time and resources usually taken up by typical clinical documentation, allowing you to focus on providing patients with the best care.

Beran, M. S., & Craft, C. (2015). Medicare annual wellness visits: Understanding the Patient and Physician Perspective. Minnesota Medicine, 98(3), 38-41. https://www.researchgate.net/profile/Cheryl-Craft-3/publication/275054301_Medicare_annual_wellness_visits_Understanding_the_patient_and_physician_perspective/links/569fb0c908ae4af52546c339/Medicare-annual-wellness-visits-Understanding-the-patient-and-physician-perspective.pdf

Chartspan (n.d.). Ultimate Medicare Annual Wellness Visit Checklist for Providers. https://www.chartspan.com/blog/ultimate-medicare-annual-wellness-visit-checklist-for-providers/

Ganguli, I., Souza, J., McWilliams, J. M., & Mehrotra, A. (2020). Association of Medicare’s Annual Wellness Visit with Cancer Screening, Referrals, Utilization, and Spending. PubMed Central, 38( 11 ), 1927-1935. 

doi: 10.1377/hlthaff.2019.00304

HCRpath, (2023). Medicare Wellness Exam Checklist for Providers. https://www.hcrpath.com/medicare-wellness-exam-checklist-for-providers/

Medicare Learning Network (n.d.). Medicare Wellness Visits. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html

Metrocarephysicians (n.d.). Annual Wellness Visit (AWV) Practice Checklist. https://www.metrocarephysicians.com/images/AWV_VISIT_WORKFLOW_CHECK_LIST_with_screens.pdf

Commonly asked questions

A Medicare Annual Wellness Visit Checklist can be created using the downloadable Medicare Annual Wellness Visit Checklist PDF from Carepatron. This checklist can be used as a reference to build your own standardized checklist to suit your practice, and our example can provide a visual reference of how this checklist would function in a real AWV procedure.

These resources are used for healthcare professionals, such as general practitioners and pediatricians, to conduct a thorough Medicare Annual Wellness Visit (AWV). The checklist can be used to inform standardized procedures for AWVs to identify risk factors and construct or update personalized prevention plans (PPP) for patients to maintain or enhance health.

Medicare Annual Wellness Visit Checklists provide a standardized structure for healthcare providers, such as general practitioners and pediatricians, to follow when conducting a Medicare AWV. It has steps to ensure a comprehensive procedure that targets patient wellness.

A Medicare Annual Wellness Visit (AWV) Checklist can be created by healthcare providers intending to complete Medicare AWV. However, healthcare providers should ensure they meet the requirements and guidelines set by Medicare to ensure best practice. For this reason, healthcare providers may find our Medicare Annual Wellness Visit Checklist to be a comprehensive foundation to inform best practices, from which you can then adapt to suit your practice and patient needs. 

Related Templates

Annual Wellness Visit

Are you conducting Annual Wellness Visits? Enhance efficiency with this Annual Wellness Visit Checklist. Get this downloadable format for seamless healthcare.

Popular Templates

Massage Therapy Invoice Template

Get access to a free Massage Therapy Invoice Template with Carepatron. Streamline your documentation and invoicing process with our PDF.

Ankle Injury Diagnosis Chart

Learn more about ankle injuries and have a step-by-step guide on diagnosing them with our free ankle injury diagnosis chart template.

Health Triangle Worksheets

Explore and improve your well-being across physical, mental, and social health with our comprehensive Health Triangle Worksheets.

Cholecystitis Treatment Guidelines

Explore our Cholecystitis Treatment Guidelines for managing acute conditions. Download the PDF now.

Schizophrenia Treatment Guidelines

Discover the latest Schizophrenia Treatment Guidelines, including antipsychotic medication, psychosocial interventions, and cognitive behavioral therapy.

Breast Cancer Treatment Guidelines

Explore comprehensive Breast Cancer Treatment Guidelines for informed decisions. Learn about the latest protocols and options for adequate care.

Rheumatoid Arthritis Diagnosis Criteria

Learn about the essential Rheumatoid Arthritis Diagnosis Criteria for accurate identification and timely treatment in healthcare.

Face Sheet (Medical)

Explore the benefits of using a medical face sheet for efficient patient care, including quick patient data access and insurance verification.

Medicare 8-minute Rule Chart

Master the Medicare 8-Minute Rule with our comprehensive chart and guide. Simplify billing for time-based therapy services and maximize reimbursement.

Cataract Evaluation

Streamline your Cataract Evaluation process by using our template for documentation. Download for free today!

Wheelchair Evaluation

Download our Wheelchair Evaluation template to streamlines the documentation process through a evaluation of clients' mobility and seating needs.

Pediatric BMI Chart

Download our Pediatric BMI Chart for a resource that can assist you in assessing and documenting a child's weight status.

Bariatric Psychological Evaluation

Explore our comprehensive guide on Bariatric Psychological Evaluation to understand the importance, process, and benefits for surgery candidates.

Medical Fishbone Diagram

Explore the Medical Fishbone Diagram to identify the causes of healthcare issues with our free PDF template. Streamline problem-solving in clinical settings.

Navicular Stress Fracture Test

Explore diagnosis and treatment for navicular stress fractures with our free guide on tests, symptoms, and recovery strategies.

Triphasic BBT Chart

Discover how a Triphasic BBT Chart can help track fertility and early pregnancy signs. Download our free PDF for insights and examples.

Scaphoid Fracture Test

Explore the essential aspects of scaphoid fractures, including symptoms, risk factors, and treatments. Access our free Scaphoid Fracture Test PDF for better patient care.

Female Acupuncture Points Chart

Explore our Female Acupuncture Points Chart for a comprehensive guide on key acupuncture points and meridians to enhance women's health treatments.

Musculoskeletal Examination Checklist

Explore a comprehensive guide on musculoskeletal system examination, conditions, treatments, and FAQs with a free checklist PDF download.

Pain Management Coding Cheat Sheet

Streamline your medical billing and coding for pain management with our comprehensive cheat sheet. Download our free PDF today.

Body Neutrality Worksheet

Explore our Body Neutrality Worksheet to help individuals foster self-acceptance and focus on the functionality of their bodies. Download it now!

Massage Therapy Business Plan

Creating a massage therapy business plan? Download Carepatron's free PDF to guide you through the process and help you create a successful massage therapy business plan.

Food and Symptom Diary PDF

Track your food intake and symptoms on a symptom-free day with our convenient Food and Symptom Diary PDF report. Monitor your health quickly and effectively.

Newborn Exam Template

Streamline newborn examinations with our comprehensive template, ensuring thorough newborn assessment and care. Download now!

Learning Needs Assessment Nursing

Unleash your full potential! Master nursing skills & knowledge with Carepatron's LNA guide. Boost patient care & career growth.

Hypochondria Test

Explore our guide on illness anxiety disorder: signs, impact, and treatments. Download a free Hypochondria Test to start your journey to better health.

Binocular Vision Test

Carepatron's free PDF download provides a binocular vision test example that you can use to assess your vision. Learn more about binocular vision and how to conduct the test effectively.

Radical Forgiveness Worksheet

Unlock the power of Radical Forgiveness with our comprehensive worksheet. Guide your patients to healing and transformation with our template and guide.

What is a Daily Routine Worksheet for Adults?

Become more intentional and establish structure within your day through our free worksheet. Download your free PDF here!

PASS Assessment

Explore the use of a specialized test to assess postural control among stroke patients to craft a more targeted rehabilitation plan.

Eden's Test

Discover the significance of Eden's Test in diagnosing thoracic outlet syndrome. Learn how this maneuver aids in identifying neurovascular compression.

Esthetician Business Plan

Crafting an Esthetician Business Plan is crucial for success. Download Carepatron's free PDF to guide you in creating your own professional business plan.

Test for Muscle Weakness

Learn how to determine muscle weakness with Carepatron's free PDF download and example. This resource provides valuable information on assessing muscle strength and functionality.

Healthcare Marketing Plan

Download Carepatron's comprehensive Healthcare Marketing Plan PDF, which helps create a successful strategy that drives patient engagement, trust, and growth for your organization.

Hearing Aid Evaluation

Learn how to conduct a thorough hearing aid evaluation with our free PDF download. This comprehensive guide includes examples and tips for success.

OCD Treatment Guidelines

Navigate through the complexities of OCD with our comprehensive treatment guidelines. Discover evidence-based strategies for effective management.

Behavioral Health Treatment Plan

Explore effective mental health treatment plans with our free PDF template, which is ideal for mental health professionals seeking structured recovery paths.

Classical Conditioning Worksheet

Explore classical conditioning with our worksheet, perfect for students, therapists, and self-learners to deepen their understanding of behavior theories.

Action Planning Worksheet

Maximize project success with our Action Planning Worksheet. Track and measure progress effectively. Download free templates for complete project management.

Pharmacy Technician Worksheets

Unlock pharmacy tech skills with our free worksheets for exam prep, skill refreshment, and practical knowledge. Download now.

Cross Addiction Worksheet

Carepatron offers integrated software for therapy practice management, streamlining scheduling, billing, and clinical documentation for healthcare providers.

Type 2 Diabetes Treatment Guidelines

Get comprehensive guidelines and examples for treating Type 2 Diabetes in Carepatron's free PDF download.

Pain Management Treatment

Discover effective pain management treatments and examples through Carepatron's free PDF download. Learn about various strategies to alleviate pain and improve your quality of life.

Inner Child Healing Exercises

Unlock your healing journey with Inner Child Healing Exercises. Reconnect with your inner child, heal childhood trauma, and find emotional resilience.

Burnout Recovery Plan

Get your free PDF of a burnout recovery plan from Carepatron to help you overcome burnout and regain work-life balance. Explore practical recovery strategies.

Therapy Invoice Template

Our Therapy Invoice Template streamlines billing processes, enhances professionalism, and effortlessly keeps you organized. Download now!

Muscle Test

Discover everything you need to know about muscle testing, examples, and Carepatron's free PDF download to help you better understand this technique.

Five-Facet Mindfulness Questionnaire

Measure mindfulness with an evidence-based tool to gain clients' mindfulness profiles and improve clinical outcomes through tailored interventions.

Pisiform Fracture Test

Learn how to conduct the Pisiform Fracture Test. Get a free PDF template to record results and streamline your documentation.

90-90 Hamstring Test

Learn how to perform the 90-90 Hamstring Test. Access a free PDF template and example here.

Overhead Squat Assessment

Get access to a free Overhead Squat Assessment template. Learn how to perform this test and interpret the results.

Osteoarthritis Diagnosis Criteria

Understand the signs, causes, and effective criteria for diagnosis. Download our free PDF example for a detailed understanding.

Stages of Relapse Worksheet

Download our free Stages of Relapse Worksheet to effectively track and manage signs of emotional, mental, and physical relapse.

Cervical Flexion Rotation Test

Discover the Cervical Flexion Rotation Test for assessing upper cervical spine dysfunction, ideal for diagnosing cervicogenic headaches and neck issues.

Levels of Hoarding Test

Access a resource that will aid you in evaluating a patient's hoarding disorder. Download our Levels of Hoarding Test today!

Antisocial Personality Disorder Treatment Plan

Discover an effective treatment plan for Antisocial Personality Disorder to help individuals manage symptoms and improve quality of life.

Vineland Adaptive Behavior Scale

Learn more about the comprehensive Vineland Adaptive Behavior Scale, which assesses adaptive behaviors in individuals and provides targeted support.

Norton Scale

Learn about the Norton Scale, a tool used in healthcare to assess the risk of pressure ulcers. Understand its significance and application.

Medical Diagnosis Form

This form helps healthcare professionals gather patient information for accurate diagnosis. Download a free medical diagnosis form template.

Authenticity Test

Discover how authentic you are with our Authenticity Test. Uncover your true self, live more authentically, and improve your life satisfaction. Try it now!

IFS Treatment Plan

Download Carepatron's free PDF example of an Internal Family Systems (IFS) treatment plan. Learn how to create a comprehensive treatment plan using IFS therapy techniques.

Beers Criteria Template

Explore the Beers Criteria Template, guiding principles for safer medication use in older adults—essential knowledge for healthcare professionals.

Non-Medical Home Care Assessment Form PDF

Download, print, and fill out our Non-Medical Home Care Assessment Form PDF for thorough evaluation and personalized care plans. Streamline your caregiving process today!

Miracle Question Worksheet

Use a helpful tool when practicing solution-focused therapy to engage and build motivation among clients. Download your free PDF here.

Premenstrual Dysphoric Disorder DSM-5

Explore the criteria of Premenstrual Dysphoric Disorder (PMDD) as outlined in DSM-5, shedding light on panic disorder and its impact on mental health.

AC Joint Test

Explore AC Joint Test procedures, results interpretation, and next steps for managing injuries like AC joint separation and arthritis.

Discover the ins and outs of the PVD Test with our comprehensive guide and template. Learn about its purpose, procedure, risks, and more.

Immature Personality Disorder Test

Assess and understand immature personality disorder with Carepatron's free PDF test and examples. Get insights into this personality disorder and learn more about it.

Stinking Thinking Worksheet

Download our Stinking Thinking Worksheet to help clients challenge negative thoughts and cognitive distortions.

Snapping Hip Test

Gain access to an essential resource, the Snapping Hip Test, to assist you in diagnosing a snapping hip during physical assessments. Download today!

R Worksheets for Speech Therapy

Enhance your speech therapy sessions with R Worksheets, designed to improve articulation skills. Download the free PDF sample today!

Hip Quadrant Test

Learn how detailed records promote quality of care for patients with hip pathologies. Download our Hip Quadrant Test to document the process.

Shame Resilience Theory Template

Download a free resource that clients can use for a more goal-directed approach to building shame resilience.

Disruptive Mood Dysregulation Disorder Treatment Plan

Unlock efficient anxiety care with Carepatron's software, featuring patient management tools, secure communication, and streamlined billing.

Multiple Sclerosis Test

Discover the symptoms, causes, diagnosis, and treatment options for Multiple Sclerosis and understand comprehensive care approaches.

MCL Injury Test

Discover key insights on MCL injuries, from symptoms and diagnosis to recovery. Get expert advice for effective treatment and healing.

Dermatomyositis Diagnosis Criteria

Learn about the diagnostic criteria for dermatomyositis and see an example with Carepatron's free PDF download. Get the information you need to understand this condition.

Hip Mobility Test

Learn how to assess your hip mobility with a simple test. Download Carepatron's free PDF guide with examples to improve hip flexibility and function.

Massage Chart

Explore our comprehensive Massage Chart for holistic healthcare solutions and techniques. Perfect for practitioners and enthusiasts alike!

Occupational Therapy Acute Care Cheat Sheet

Streamline patient recovery with key strategies for enhancing independence in acute settings. Download our free Occupational Therapy Acute Care Cheat Sheet.

Neck Pain Chart

Explore our comprehensive Neck Pain Chart for insights into causes, symptoms, and treatments. Find relief and understanding today.

Sedation Scale Nursing (Ramsay Sedation Scale)

Discover key sedation scales used in nursing, including RASS and Ramsay Scale, for accurate patient sedation assessment in critical care settings.

Blood Tests for Lupus

Download a free Blood Tests for Lupus template. Learn the various types of tests used to diagnose this disease.

Neurological Exam Template

Discover the importance of neurological assessments for diagnosing and monitoring conditions with our comprehensive guide and template. templates

Homeopathic Dosage Chart

Discover the principles of homeopathy, dosage guidelines, and effectiveness, with references and a downloadable chart for practical use.

Gout Diagnosis Criteria

Uncover the essential Gout Diagnosis Criteria here, including symptoms, diagnostic tests, and the American College of Rheumatology guidelines.

Peroneal Tendon Tear Test

Learn about the Peroneal Tendon Tear Test and use our template to record results!

Ear Seeds Placement Chart

Learn what ear seeds are and download our Ear Seeds Placement Chart template!

Global Rating of Change Scale

Explore the Global Rating of Change Scale, a key tool to assess the clinical significance of patient-reported outcomes. Get your free PDF template now.

Physical Therapy Initial Evaluation

Unlock the benefits of Physical Therapy Initial Evaluation: a key step in personalized treatment planning for improved mobility and pain relief.

8-Week Group Counseling Plan

Discover a flexible template for creating effective 8-Week Group Counseling Plans, tailored to meet diverse needs and foster growth.

Osteoarthritis Treatment Guidelines

Learn about the management of osteoarthritis, treatments, causes, and care strategies. Access tips for managing symptoms and improving quality of life in our guide.

Prone Knee Bend Test

Learn about the Prone Knee Bend Test and how it assesses radicular pain.

PTSD Treatment Guidelines

Download our PTSD Treatment Guidelines template to access evidence-based treatment plans, diagnostic tools, and personalized care strategies.

Assess alcohol use with AUDIT-C: quick, accurate alcohol screening tests for hazardous drinking. Learn your risk level in minutes. Download our free template now!

Cincinnati Stroke Scale Scoring

Learn to quickly identify stroke symptoms with the Cincinnati Stroke Scale Scoring guide, which is essential for emergency responders and healthcare professionals.

Lupus Diagnosis Criteria

Download a helpful checklist tool to help diagnose lupus among patients for early identification and intervention. Access your free resource here!

Quadriceps Strain Test

Get access to a free Quadriceps Strain Test template. Learn how to interpret results and streamline your documentation with a free PDF.

Dysarthria Treatment Exercises

Discover effective dysarthria exercises to improve speech clarity. Download our free guide for tailored speech therapy techniques.

Antisocial Personality Disorder Test

Use a helpful evidence-based Antisocial Personality Disorder Test to identify ASPD symptoms among clients and improve health outcomes.

Normal Blood Sugar Levels Chart

Understand how a Normal Blood Sugar Levels Chart works. Get access to a free PDF template and example in this guide.

Height Weight Charts

Learn about height-weight charts and their use in healthcare practice. Find out your ideal weight and stay healthy!

Glasgow Coma Scale

The Glasgow Coma Scale (GCS) dates back to the 1970s and has become one of the most widely accepted measurements of impairment following brain injury. What better way to start using the GCS in your practice than with Carepatron’s free PDF GCS template download.

A1C Goals By Age Chart

Use our free A1C Goals by Age Chart to learn the recommended A1C goal for people of different ages. Download our free PDF and example here.

Nuclear Heart

Get access to a free Nuclear Heart Test Report template. Document your patient results with a user-friendly PDF template.

Health Physical Exam

Optimize your healthcare practice with our Health Physical Exam Template. Streamline assessments, track vital signs, and enhance patient care. Download now!

HGB A1C Conversion Chart

Efficiently convert HGB A1C values with our user-friendly HGB A1C Conversion Chart. Simplify diabetes management. Download PDF now.

Medical History Form

Check out our medical history form template to elevate the quality of care within your healthcare practice. Ensure that your patient information is accurate and up-to-date.

Ferritin Level

Monitor iron status effectively with our Ferritin Level Chart�??a valuable tool for healthcare professionals.

Non Fasting Blood Sugar Levels Chart

Understand Non Fasting Blood Sugar Levels Chart clinical significance in managing blood sugar levels and optimizing patient care.

Vital Sign Sheets

Implement our vital signs sheet into your healthcare practice to automate data collection. Improve accuracy, organization, and achieve better clinical outcomes today.

Fever Temperature Chart

Track your health with precision using our Fever Temperature Chart. Monitor temperature symptoms and get medical help for optimal care.

Join 10,000+ teams using Carepatron to be more productive

• Annual Wellness Visit
• Preventive Care
• Chronic Care Management
• RPM Overview
• Management of Disease States
• Cardiology Patient Monitoring
• Endocrinology Patient Monitoring
• Gastroenterology and Bariatrics Patient Monitoring
• Pulmonology Patient Monitoring
• Resource Library
• ROI Calculator
• Working with Prevounce

• Annual Wellness Visits

• Medicare Annual Wellness Visit

Annual Wellness Exam Medicare Checklist: 12 Items for Providers

• Remote Patient Monitoring (41)
• Chronic Care Management (21)
• Medicare Annual Wellness Visit (19)
• Preventive Care (12)
• Prevounce News (12)
• Compliance (9)
• Remote Care Management (9)
• Centers for Medicare & Medicaid Services (7)

by Lucy Lamboley

The Medicare annual wellness visit (AWV), sometimes referred to as a Medicare annual wellness exam, is an important part of keeping patients healthy. Unfortunately, the requirements concerning completing and documenting AWV appointments can be complex, so it is common for providers to inadvertently miss steps or fail to complete a requirement. In fact, as this Physicians Practice column by Prevounce CEO Daniel Tashnek, JD, notes, a survey from just a few years ago found that upwards of about 85% of Medicare AWVs may fail to meet compliance requirements set forth by the Centers for Medicare & Medicaid Services (CMS).

If you miss a requirement once, it may become the norm for you or your staff to skip that step in the Medicare AWV process . For instance, you may create a care plan for the patient, but not give it to them. Or you may create the service schedule, but neglect to personalize it to the patient. Any such oversight can diminish the value of the Medicare annual wellness visit and potentially lead to clawbacks and other penalties. Egregious and willful cases of noncompliance could lead to more serious ramifications.

Uncertainty concerning proper completion of the Medicare annual wellness visit can make it more difficult for providers and patients to get the most out of these wellness visits.

12 Items Needed for a Compliant Medicare Annual Wellness Visit

To help you better ensure every AWV is documented and completed properly, follow this Medicare annual wellness exam checklist.

1. Verify eligibility

Medicare, along with all types of insurance providers, has rules for the services a patient is eligible for and when. In the case of annual wellness visits, the timing of the appointment is particularly important. Medicare will only cover AWV appointments if a patient has been enrolled in Medicare for more than twelve months and has not had a wellness visit or " Welcome to Medicare " preventive visit in the preceding twelve months. Determining eligibility can be a

time-consuming process if not automated (such as through a AWV software platform like Prevounce) as it’s typically completed over the phone, through the MAC portal, or via clearinghouse. But verifying eligibility before any services take place helps protect both the provider organization and the patient from the financial burdens that can be caused by rejected claims. To help you better understand who is and is not eligible for the AWV, download this AWV eligibility quick guide .

2. Communicate requirements and expectations

Preventive health is a partnership between a provider and patient. For a patient to be fully prepared to participate in their annual wellness visit, it is important for organizations to proactively communicate so patients are aware of what they need to do to prepare, including the information they should bring to the AWV. It is also necessary to communicate what patients should expect from their visits.

Many people mistakenly believe a Medicare annual wellness visit will include a physical exam or other diagnostic procedures. Helping patients understand in advance what an AWV entails will help avoid both confusion and frustration. If you are wondering why Medicare does not cover annual physical exams, read this blog post.

If you are wondering why Medicare does not cover annual physical exams, read this blog post.

3. Complete a health risk assessment (patient responsibility)

Tasking patients with completing a health risk assessment (HRA) is a critical step in this Medicare annual wellness exam checklist because HRAs help providers identify factors that could negatively impact a patient’s health. They also provide clinicians with information needed to reconcile existing medication and health records with the patient’s responses, which is a required component of the Medicare AWV.

Ideally, assessments should be completed digitally before the patient comes to their appointment. Filling them out ahead of time allows the patient to allocate the necessary time to gather required information, such as family medical history or the names and dosages of their medications. However, if someone chooses to complete the health risk assessment in the office, technology like the Prevounce platform can still simplify the process for patients and providers.

4. Identify current medical providers

Many patients work with several providers to support their various healthcare needs. Creating a record of each of a patient’s providers, including pharmacies and medical equipment suppliers, is essential to understanding current and future medical needs.

5. Routine measurements

Another important part of the Medicare annual wellness visit is the practice of collecting vitals and other measurements. The simple practice of tracking information such as weight, blood pressure, and body mass index over time can help identify concerning trends in a patient’s health.

6. Cognitive assessment

Some Medicare patients may be at elevated risk for experiencing diminished cognitive abilities, which can negatively impact their quality of life and prevent them from caring for themselves. Assessing the cognitive awareness of patients is key to helping keep them healthy and safe by identifying cognitive decline earlier.

Cognitive assessments may be completed using formal tools, such as those provided by the National Institute of Aging , and/or they may be based on direct observation and input from family members, friends, and caregivers.

7. Mental Health Assessment

Mental health conditions, such as depression, negatively impact the lives of a growing number of patients . There are many screening tools, such as those provided by the American Mental Wellness Association , that can assist providers as they work to identify and then appropriately address these conditions.

8. Everyday living and safety assessment

As patients age, they may lose the ability to complete activities necessary for everyday living. As a result, it is crucial to screen for concerns such as a patient’s inability to fulfill their nutrition or hygiene needs. Assessing if a patient lives in an environment that does not put them at undue risk for falls or other accidents is also critical for helping keep them safe.

9. Document risk factors

Using the information gathered in all of the recommended assessments, it is important to compile and document a list of potential risks that may negatively impact a patient now or in the future. This list should include the risks themselves and advantages and disadvantages of any treatment options.

10. Provide a plan for the future

The final step* of the in-office portion of the Medicare annual wellness visit is to use the gathered information through the AWV process to provide a patient with guidance on how to maintain or improve their health. This process includes three important steps:

• Provide the patient with a personalized plan that includes specific medical advice and strategies for addressing identified risks.
• Work with the patient to create an actionable screening schedule that provides the patient with a checklist for all recommended preventive medicine screenings over a 5-10-year period.
• The third step, which is commonly missed, is to provide the patient with a physical copy of both the personalized patient plan and preventive screening schedule.

Since creating the screening schedule and personalized plan can be extremely time-consuming, automating these steps by using technology can reduce the time required for completing and significantly decrease the risk of errors.

This checklist should be based both on the results of assessments and on recommendations from the U.S. Preventive Services Task Force (USPSTF) .

11. Coding and billing correctly

After a patient completes their appointment, the next item on the checklist is to correctly code and bill for the provided services. It is imperative that providers properly following the rules for Medicare annual wellness visit coding and billing as failing to complete the process correctly can result in either rejected claims or penalties incurred from being found non-compliant during audits. Either result translates to a loss of revenue for the provider. For assistance with following Medicare AWV coding and billing rules, read this post .

12. Optional: advanced care planning (ACP)*

We included an asterisk with item 10 of the checklist concerning providing a future plan for patients because there may be one additional step for the in-office portion of the Medicare annual wellness visit. Advanced care planning (ACP) is optional but covered under Medicare during AWVs. Issues such as who a patient trusts to make their medical decisions if they are unable to communicate or which medical interventions they are or are not comfortable with can be important issues to discuss and document. However, not all patients are comfortable talking about these topics, so advanced care planning should be done at the patient’s discretion.

Streamlining Completion of the Medicare Annual Wellness Visit With Prevounce

We designed the Prevounce platform to help make Medicare annual wellness visits more beneficial for patients and providers. Schedule a demo today to see how our platform provides the tools that make the AWV process simpler by automating pre-visit communication, verifying eligibility, supplying step-by-step walkthroughs, and providing coding and billing support so that annual wellness visits are completed, billed, and paid correctly every time.

Lists by Topic

• Medicare (7)
• Telehealth Regulation and Law (6)
• Billing (4)
• Connected Medical Devices (2)
• Patient Resources (2)
• Arthritis (1)
• Chronic Pain Management (1)
• Diabetes (1)
• Mental Health (1)

Subscribe and Get The Latest News

Related posts, examples of remote patient monitoring: 9 top patient applications.

The use of remote patient monitoring — i.e., remote physiologic monitoring or RPM — has surged over the past few years. It's been widely embraced by providers, patients, the federal government, and an increasing number of commercial payers. Numerous statistics show the value of RPM, and when we look at some of the more common examples of remote patient monitoring applications, it is easy how RPM is transforming the delivery of care in the United States. 

• Lucy Lamboley
• 17 min read
• April 5, 2024

Quick Guide: Remote Patient Monitoring CPT Codes to Know in 2024

Over the last few years, remote patient monitoring (RPM), also referred to as remote physiologic monitoring, became one of the more lucrative Medicare care management programs. Using average 2024 RPM reimbursement rates, if 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, that will generate annual reimbursement of nearly $113,000.

• 13 min read
• March 22, 2024

AMA Weighing Substantial Expansion of Remote Patient Monitoring Codes

The American Medical Association (AMA) has announced the agenda for its second quarter 2024 CPT Editorial Panel meeting in May, and it includes discussion on what would be a significant and welcome expansion of remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) CPT codes.

• Daniel Tashnek
• March 11, 2024

Prevounce creates wellness that works for everyone, with practice-specific, software-based programs that make preventive care, chronic care management, and remote patient monitoring easier to prep for, perform, document, and bill.

Wellness Program

• Medicare Preventive Services
• Remote Patient Monitoring
• MACRA & MIPS

©  Copyright  2023 Prevounce - All Rights Reserved

Status | Privacy Policy | Do Not Sell My Information

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?

Tip: Turn on your clipboard history .

Find us at Mastodon , Facebook , Threads , Twitter , Reddit , Youtube , & Linkedin

Check out the cheat sheet – you can print it off if you’d like.

5 well-known features and 5 hidden gems

ROUTINE WELLNESS/FOLLOW-UP Visit

• View Live Form Edit Markup Data Dictionary

There are 92 form elements.

• Fill from CSV file

Fill from CSV data

Result - copy and paste this output:.

• Save to CSV file
• Show CSV data

ROUTINE WELLNESS/FOLLOW-UP Visit. ​​The SOAPnote Project. https://www.soapnote.org/complete/episodic-visit/. Published August 29, 2021. Updated September 14, 2021. Accessed April 27, 2024.

Send Feedback for this SOAPnote Cancel reply

Your email address will not be published. Required fields are marked *

• Medication F/U
• EPISODIC VISIT*

Annual Wellness Visit

What is the medicare annual wellness visit (awv).

The Annual Wellness Visit (AWV) allows practices to gain information about the patient, including medical and family history, health risks, and specific vitals. Not to be confused with a complete physical examination, the purpose of the AWV is to review the patient’s wellness and develop a personalized prevention plan. The services provided during the AWV are different from a typical preventive care visit and expand to include emotional and psychological well-being, in addition to the patient’s physical well-being. The AWV provides an opportunity for physicians to improve the quality of care, assist in patient engagement, and optimize payment opportunities.

Take Action

Optimize revenue and improve patient outcomes with Medicare's Annual Wellness Visits. These visits help you identify care gaps, increase revenue, and prepare your practice for value-based care.

The two CPT codes used to report AWV services are:

• G0438 initial visit
• G0439 subsequent visit

Requirements and Components for AWV

Requirements and components for G0438 (initial visit) include:

• Patient is eligible after the first 12 months of Medicare coverage.
• For services within the first 12 months, conduct the Initial Preventive Physical Exam (IPPE), also referred to as the Welcome to Medicare Visit (G0402).
• The patient must not have received an IPPE within the past 12 months.
• Administer a Health Risk Assessment (HRA) that includes, at a minimum: demographic data, self-assessment of health status, psychosocial and behavioral risks, and activities of daily living (ADLs), instrumental ADLs including but not limited to shopping, housekeeping, managing own medications, and handling finances.
• Establish the patient’s medical and family history.
• Establish a list of current physicians and providers that are regularly involved in the medical care of the patient.
• Obtain blood pressure, height, weight, body mass index or waist circumference, and other measurements, as deemed appropriate.
• Assess patient’s cognitive function.
• Review risk factors for depression, including current or past experiences with depression or mood disorders.
• Review patient’s functional ability and safety based on direct observation, or the use of appropriate screening questions.
• Establish a written screening schedule for the individual, such as a checklist for the next 5 to 10 years based on appropriate recommendations.
• Establish a list of risk factors and conditions for primary, secondary, or tertiary intervention.
• Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
• At the patient's discretion, furnish advance care planning services.

Requirements and provisions for G0439 (subsequent visit) include:

• Billable for subsequent AWV.
• The patient cannot have had a prior AWV in the past 12 months.
• Update the HRA.
• Update the patient’s medical and family history.
• Update the current physicians and providers that are regularly involved in providing the medical care to the patient, as developed during the initial AWV.
• Obtain blood pressure, weight (or waist circumference, if appropriate), and other measurements, as deemed appropriate.
• Update the written screening schedule checklist established in the initial AWV.
• Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.
• At the patient's discretion, the subsequent AWV may also include advance care planning services.

Health Care Professionals Who May Furnish and Bill AWV:

• Physician assistant (PA)
• Nurse practitioner (NP)
• Clinical nurse specialist (CNS)
• Medical professional (including a health educator, registered dietician or nutrition professional, or other licensed practitioner) or a team of medical professionals working under the direct supervision of a physician.)

Non-physicians must legally be authorized and qualified to provide AWVs in the state in which the services are furnished.

Talk to Your Medicare Patients about AWV

Better patient care starts with preventive wellness visits. Download the AAFP’s patient flier and use it to talk with your Medicare patients about the importance of scheduling a free, personalized prevention visit with you.

• Download the patient flyer »(1 page PDF)
• Download the patient letter »(1 page PDF)

Step-by-Step Approach to Adding Annual Wellness Visits to Your Practice

The Annual Wellness Visit (AWV) can be added to your small practice with existing staff and minimal impact to your operations. The AWV identifies care gaps and preventive services, increases revenue, and prepares your practice for value-based payment.

Read more about AWVs in the Making Sense of MACRA: Annual Wellness Visit supplement »

The AAFP’s Position on AWVs

The AAFP supports this preventive coverage as it provides an opportunity to deliver, document, and bill for the service. Implementing the service allows physicians to invest in patient-centered, team-based care while promoting quality and cost-effective care.

What You Need to Know

It is important to remember that code G0438 is for the first AWV only. The submission of G0438 for a beneficiary for which a claim code of G0438 has already been paid will result in a denial. This benefit is covered at 100% for the beneficiary.

Approaches to Help Your Practice Get Started

• AWV can be provided to all Medicare Part B patients.
• Use this service to identify patients who would benefit from a discussion regarding their self-management goals.
• Choose patients the staff has identified as highest risk (i.e., staff are concerned that the patient is unstable or may be more likely to need additional services or have recently been to the ER).
• Use this service to risk stratify your patient population.
• Use this service to document diagnoses and conditions to accurately reflect patient severity of illness (hierarchical condition category [HCC] coding) and risk of high-cost care. 

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.