Annual Wellness Visit

Identify care gaps, increase revenue, and prepare your practice for value-based care with Medicare's Annual Wellness Visits.

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.

AWV Coding

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.

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.

Requirements and Components for AWV

Requirements and components for G0438 (initial visit) include:

• Billable for the first AWV only.
  • 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.
  
• Assess patient’s cognitive function.
  
• 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.
  
• 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, the subsequent AWV may also include advance care planning services.
  

Health Care Professionals Who May Furnish and Bill AWV:

• Physician
  
• 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.

Tips for getting started with AWVs

• AWVs 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. 

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)

AWV Webinar