Medicare Annual Wellness Visit: What It Is and Why It Matters

The Medicare Annual Wellness Visit, commonly called the AWV, is a preventive visit used to develop or update a personalized prevention plan based on the patient's health, risk factors, medical history, family history, and individual needs.

It is important to understand that an AWV is not the same as a traditional head-to-toe physical examination. CMS describes the AWV as a "visit to develop or update a personalized prevention plan and perform a health risk assessment."

What is the purpose of the AWV?

The purpose of the AWV is to help you and your clinician look at your overall health, identify risks, determine which preventive services may be appropriate, and create or update a personalized prevention plan. The AWV is centered on prevention, planning, early identification of health concerns, and helping you remain engaged in your care.

Who may be eligible?

A Medicare patient may be eligible for an AWV when:

• The patient has Medicare Part B.
• The patient is outside the first 12 months of their initial Medicare Part B coverage period, unless other applicable eligibility requirements are met.
• The patient has not received an eligible AWV or certain other conflicting Medicare preventive visits during the applicable 12-month period.
• The provider verifies eligibility before billing.

The first Medicare AWV is generally billed using HCPCS code G0438. Subsequent AWVs are generally billed using HCPCS code G0439.

What happens during an AWV?

The AWV normally includes a Health Risk Assessment and a review of your health and preventive needs. Depending on whether it is your first or a subsequent AWV, the clinician may review or update:

• Medical history, surgical history, and family health history
• Current medications and supplements
• Allergies and previous illnesses or treatments
• Basic health measurements such as height, weight, blood pressure, and BMI
• Depression, stress, loneliness, and social isolation
• Tobacco use, physical activity, nutrition, and alcohol use
• Difficulty with daily activities like dressing, eating, walking, or bathing
• Instrumental activities like using the telephone, preparing food, or managing finances
• Cognitive impairment detection
• Fall-risk assessment

Can I complete the AWV from home?

Yes. CMS permits Medicare payment for eligible AWVs furnished through telehealth when applicable Medicare requirements are satisfied. You may be able to complete the visit from home by telephone or secure video when permitted and clinically appropriate.

What does the AWV cost?

Under Original Medicare, eligible patients generally pay nothing for the covered AWV when the provider accepts Medicare assignment. However, additional cost sharing may apply if the clinician performs a separate medically necessary service beyond the AWV, or if the patient has a Medicare Advantage plan with different billing requirements.