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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.

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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 CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans.

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.

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

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

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

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

Covered services

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

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

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

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

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

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

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Your Medicare annual wellness visit: Preventive care, health planning at no extra cost

Most of us know that it’s important to see a doctor for an annual checkup. During your working years, that annual checkup typically means a full physical. But once you become eligible for Medicare, you’ll likely start hearing about something called an  annual wellness visit .

Unlike a standard head-to-toe physical, an annual wellness visit is primarily focused on preventive care, health screenings and wellness planning. It gives you an opportunity to have a conversation with your doctor about your health status and goals – then create a long-term plan to help you meet those goals and maximize your well-being.

While Original Medicare doesn’t cover an annual physical, some Medicare Advantage plans do. However, everyone enrolled in Original Medicare or Medicare Advantage is eligible for an annual wellness visit at no additional cost.  If your Medicare Advantage plan includes coverage for an annual comprehensive physical exam, ask your provider if the annual wellness visit and the physical can be scheduled during the same visit.

Below you’ll find an overview of what to expect from your annual wellness visit – and hopefully the motivation to schedule one.

Taking stock of your medical history

Your primary care provider , whether in person or virtually , will review your relevant medical history, including major illnesses, surgeries, plus any current medical conditions and medications you’re taking.

Your doctor’s office may send you a form ahead of your appointment that includes a list of questions. 

To-do : Fill out this form in advance to help ensure your doctor has a thorough understanding of your health history. It may also remind you of questions you might want to raise at the appointment.

If you don’t get a form before your visit, you should still be prepared to be as detailed as possible when describing any past medical procedures and illnesses. Knowing specific diagnoses and dates will certainly help, but even giving a rough description of any major medical events in your life will help your physician understand both your past and current medical issues.

The who’s who of your health care team

Keeping you healthy is a group effort, and the primary care provider you see for your wellness visit will want to know who’s part of your health care team. He or she may also want to work closely with other health care professionals involved in your care.

To-do : Be prepared to give the person conducting your visit a list of your current health care providers, including contact information and fields of specialty.

If you see several specialists to help you manage chronic conditions or haven’t seen some of your doctors in the past year, it can be easy to forget their names. That’s why it’s a good idea to create a list of your doctors and bring it with you to your wellness visit.

You may have chosen a health care surrogate or a proxy who will speak on your behalf should you ever become too sick to speak for yourself. If so, bring a copy of your completed forms to your appointment. If you haven’t made your choices yet, this is a good time to get your physician’s advice on your personal advance care planning .

An Rx for a productive medication review

Getting a full rundown of all your vitamins, minerals, herbal supplements and prescription medications can help the doctor spot potential drug interactions that could be harmful to your health. He or she will also want to ensure you have a complete understanding   of each medication, its purpose and any potential side effects.

To-do: Make a list, including how often you take each medication and the dosage. Or, bring all your pill bottles with you to your appointment and show them to the provider.

Stats and screenings

A clinician will check your height, weight and blood pressure, and then your provider will likely ask you some questions, including how you have been feeling recently. These questions are designed to test your cognitive function and screen you for depression. Answer them as honestly as possible and come to the appointment well-rested so you can perform your best on the tests.

Creating a wellness plan

After completing all tests and assessments, your provider will be ready to assess your current health status and work with you to develop a plan to meet your health goals. That plan will address how to treat your current conditions and how to help prevent future health problems. If you have any risk factors for developing new conditions, your provider will give you some options for managing those risks.

You can also set up a schedule for preventive care or screening tests and discuss treatment options for any newly diagnosed conditions.

To-do : Be prepared to get the most out of this planning by developing a list of questions you would like to ask at the appointment. And don’t be shy with your questions. During the annual wellness visit, your provider may have more time than usual to listen to your concerns and answer your questions.

It’s also important to be honest about your health goals. Not everyone sets out to exercise daily or lose 10 pounds in the next year – and that’s OK. Maybe your goal is to ride a bike with your grandkids around the neighborhood or to cut back on your alcohol consumption. Whatever your health goals are, your provider can’t help you reach them if he or she doesn’t know about them. So be as open and honest as possible during your visit.

Things to keep in mind

To avoid surprises, pay attention to these details as you get your visit on the calendar:

• Make sure the appointment is scheduled specifically as an annual wellness visit, or the provider may bill it as a normal office visit, which could be subject to a copay, depending on your plan. If you’re a UnitedHealthcare member, our dedicated customer service advocates can even help schedule your appointment for you.
• If your provider orders a test during the annual wellness visit, you may be charged any applicable lab or diagnostic copay for the recommended services.

When you are prepared, your annual wellness visit is more than just an office visit. It is your opportunity to take charge of your health and help ensure you’re on the right path to living the life you want. If you haven’t scheduled yours yet, use this as the push you need to get it on your calendar. It could be one of the most important conversations you have all year.

To learn more about how your how your UnitedHealthcare Medicare plan can help you access the care you need, visit UHCMedicareHealthPlans.com .

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Medicare Wellness Visits Back to MLN Print November 2023 Updates

What’s Changed?

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

Quick Start

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

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

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

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

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

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

✔ Covered once every 12 months

Routine Physical Exam

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

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

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

• Health Equity Technical Assistance Program
• Disparities Impact Statement

Communication Avoids Confusion

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

Initial Preventive Physical Exam

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

1. Review the patient’s medical and social history

At a minimum, collect this information:

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

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

2. Review the patient’s potential depression risk factors

Depression risk factors include:

• Current or past experiences with depression
• Other mood disorders

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

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

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

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

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

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

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

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

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

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

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

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

7. Screen for potential SUDs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part B covers an IPPE when performed by a:

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

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

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

IPPE Resources

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

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

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

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

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

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

Annual Wellness Visit Health Risk Assessment

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

Perform an HRA

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

1. Establish the patient’s medical and family history

At a minimum, document:

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

2. Establish a current providers and suppliers list

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

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

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

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

5. Review the patient’s potential depression risk factors

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

• Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

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

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

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

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

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

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

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

ACP is a discussion between you and the patient about:

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

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

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

11. Review current opioid prescriptions

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

12. Screen for potential SUDs

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

13. Social Determinants of Health (SDOH) Risk Assessment

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

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

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

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

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

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

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

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

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

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

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

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

Use these HCPCS codes to file AWV claims:

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

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

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

Part B covers an AWV if performed by a:

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

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

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

Medicare telehealth includes HCPCS codes G0438 and G0439.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AWV Resources

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

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

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

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

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

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

Know the Differences

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

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

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

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

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

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

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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.

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Common questions about Medicare annual wellness visits

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

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

Here are answers to common questions about annual wellness visits.

Why are annual wellness visits important.

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

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

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

How is an annual wellness visit scheduled?

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

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

How can I prepare for my annual wellness visit?

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

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

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

What can you expect during an annual wellness visit?

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

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

What is the cost of an annual wellness visit?

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

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

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What is the annual Medicare wellness visit?

The Medicare wellness visit is an annual visit with your primary care provider to create a personalized plan to help prevent disease and disability, based on your health and risk factors.

This free Medicare wellness visit is covered once every 12 months. You become eligible after you have been enrolled in Part B for a year or longer.

What is covered in the annual wellness visit?

The wellness visit is different from an annual physical exam where a doctor conducts a lot of tests. This exam focuses more on reviewing your medical history and risk factors and creating a prevention plan.

You’ll usually fill out a questionnaire, called a health risk assessment, as part of the visit. It can help you and your provider develop a personalized plan to stay healthy. Your provider may do the following during your wellness exam:

• Review your medical history and your family’s medical history
• Review your current providers and prescriptions
• Record your vital information, including your height, weight and blood pressure
• Provide personalized health advice
• Review potential health risks and treatment options
• Create a screening checklist for recommended preventive services
• Discuss advance care planning, such as who you want to be able to make medical care decisions on your behalf if you’re unable to do so yourself.
• Perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to review your cognitive function.
• Review potential risk factors for opioid problems if you have a current prescription for opioids.

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How does this differ from a Welcome to Medicare visit?

You are entitled to one free Welcome to Medicare visit any time during the first 12 months after you enroll in Medicare Part B. That checkup is an opportunity for your doctor to assess your health and provide a plan of future care. It serves as a baseline for monitoring your health during the annual wellness visits in subsequent years.

You do not need the Welcome to Medicare visit to qualify for later annual wellness visits. However, Medicare won’t pay for a wellness visit during the first 12 months you have Part B.

Will I face extra charges for the Medicare wellness visit?

You’ll have no deductible or copayments for your annual Medicare wellness visits if you’re enrolled in original Medicare and your provider accepts assignment, meaning he or she accepts the Medicare-approved amount as full compensation.

If you’re enrolled in a Medicare Advantage plan that has a provider network, such as an HMO or PPO, you may need to go to a doctor in the plan’s provider network to get the annual wellness visit without deductibles, copayments or coinsurance.

Keep in mind

If your health care provider performs additional tests or provides additional services during the visit that aren’t covered as part of the annual wellness benefit, you may have to pay your deductible and copayments for the additional expenses. ​

Updated July 14, 2022

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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 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 or update 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 .
• A screening schedule (like a checklist) for appropriate preventive services.
• An optional “ Social Determinants of Health Risk Assessment ” to help your provider understand your social needs and their impact on your treatment.  

Your 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 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

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Lewiston, Clarkston & Moscow Careers | Healthcare Jobs

Healthcare careers at chas health, recruiting professionals.

CHAS Health plays an essential role in providing accessible healthcare to the communities we serve. We’re a non-profit federally qualified health center that treats individuals and families from all walks of life regardless of their ability to pay.

We’re hiring medical, dental, pharmacy, and behavioral health staff for our Lewiston Idaho, Clarkston Washington, and Moscow Idaho clinics! Join our team in Nez Perce, Asotin, and Latah counties and make a difference in your community! Visit our careers portal to explore our open positions and apply today!

Available Jobs

CHAS Health has healthcare job openings available now!  We're hiring medical, dental, pharmacy, and behavioral health professionals for our clinics in Lewiston Idaho, Clarkston Washington, and Moscow Idaho health centers!

Lets Talk Benefits!

The CHAS Health employee culture and work-life balance is something that our organization puts at the top of our priority list. Providing a safe, fun, and open work atmosphere is important. We believe in celebrating our staff and celebrating frequently.

All employees are valued team members at CHAS Health. You work hard and we want your career to work hand in hand with your life. CHAS Health provides the following benefits to all employees.

Tuition Reimbursement & Continuing Education

The CHAS Health Education Assistance Program provides reimbursement for tuition, student loans, and related costs. **

Employer 401(k) Matching Retirement Plans

After one year of service and 1,000 hours worked, CHAS Health will match the employee’s contribution, up to 6% of gross wages.

Support paying down existing student debt

The  CHAS Health Loan Reimbursement Program provides reimbursement to any employee for qualified student loan payments up to $5,250 per calendar year. **

More Benefits!

Child Care Stipend* up to $5,000 per calendar year

Low-Cost Dental Plans for employees & family*

Paid Time Off 6 weeks PTO per year*

Employee Appreciation recognition programs & morale support

Medical & Vision comprehensive no-cost & low-cost plans

$350 Yearly Uniform Allowance for scrubs & more

Life Insurance & Disability CHAS pays up to $10,000*

Critical Care & Cancer insurance options*

*For employees working 20 hours or more. Benefit options vary for locum & part-time positions. **For employees working 30 hours or more. Benefit options vary for locum & part-time positions.

- About CHAS Health -

CHAS Health is a non-profit, federally qualified health center that is committed to high-quality medical, dental, pharmacy, and behavioral health services. To find out more about our organization, visit our About Us page.

The mission of CHAS Health is to improve the overall health of the communities we serve by expanding access to quality health and wellness services.

“The meaning of life is to find your gift. The purpose of life is to give it away”

―  Pablo Picasso

Spring into Health & Wellness Fair

The City of Moscow, Latah County, and Chamber of Commerce + Visitor Center are pleased to announce this year’s third annual Spring into Health & Wellness Fair, taking place on March 26, from 11 am-6 pm. This event brings the community and local organizations together with the passion to support self-wellness and a healthy lifestyle. 

The event will take place at the Latah County Fairgrounds, with Vendors setup in the main Events Center, showcasing their displays and giveaways. Some Vendors include, CHAS Health, Latah Recovery Center, American Red Cross, and Life Flight, just to name a few.

Multiple prize drawings will take place throughout the day. Participate in a fun game of bingo by visiting various Vendors. Visitors who have completed their bingo card are entered into the grand prize drawing. 

Other activities include; a Family Story Time by the Latah County Library, at 11 am; a Family Story Time by Latah County, at 4 pm; various live demonstration at the top of the hour, throughout the Fair, from local businesses. 

For more information please contact,  [email protected] .

Business and organizations interested in participating as a Vendor can register at,  https://www.latahcountyfair.com/events/2024/spring-into-health–wellness . 

Story Contact: Laura Perrigo , Community Events Specialist Phone: 208-883-7000 ext. 7233 Email: [email protected]

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