Discover what to expect during your Medicare Annual Wellness Visit. Our comprehensive FAQ guides you through eligibility, covered preventative services, and how to prepare for your upcoming health assessment.
A Medicare Annual Wellness Visit, often called an AWV, is a yearly preventive visit for people with Medicare Part B. It is used to create or update a personalized prevention plan based on your health, risk factors, medications, family history, and recommended screenings. Medicare describes preventive services as care that helps prevent illness or detect health problems early, when treatment may work best.
No. The Medicare Annual Wellness Visit is not the same as a routine physical exam. It is a preventive planning visit. The provider reviews your health history, medications, risks, screenings, and prevention needs, but it is not meant to replace care for a new symptom, illness, injury, or urgent medical concern. Medicare notes that if extra tests or services are performed during the same visit and are not covered under the preventive benefit, additional costs may apply.
You may be eligible for a yearly Wellness Visit if you have had Medicare Part B for more than 12 months. Your first yearly Wellness Visit cannot take place within 12 months of your Part B enrollment or within 12 months of your “Welcome to Medicare” preventive visit. You do not need to have had a “Welcome to Medicare” visit to qualify for a yearly Wellness Visit later.
Medicare covers the Annual Wellness Visit once every 12 months for eligible beneficiaries. CMS also states that the billing codes for the first AWV and later AWVs may only be billed once in a 12-month period.
Yes. CMS states that Medicare pays for Annual Wellness Visit codes G0438 and G0439 when the services are provided by telehealth. CMS also lists Medicare telehealth services payable under the Medicare Physician Fee Schedule.
An Annual Wellness Visit may include a health risk assessment, review of medical and family history, review of current providers and medications, basic measurements such as weight and blood pressure, cognitive screening, depression risk review, fall risk and safety review, and a written screening schedule based on your health needs. CMS also says the AWV includes a personalized prevention plan of service.
Yes. The purpose of the AWV is to help develop or update a personalized prevention plan. CMS lists the AWV billing codes as including a personalized prevention plan of service, and the visit may include a written screening schedule based on your health risk assessment, age, screening history, and covered preventive services.
It helps to have your medication list, supplements, family health history, immunization records, current providers, and any recent health changes ready. CMS encourages patients to prepare for the AWV by bringing medical records, a detailed family health history, a full list of medications and supplements, and a list of current providers and suppliers involved in their care.
Medicare.gov says you pay nothing for the yearly Wellness Visit if your doctor or other health care provider accepts assignment, and the Part B deductible does not apply. However, if additional tests or services are performed during the same visit that Medicare does not cover under the preventive benefit, you may have coinsurance, a deductible, or other costs.
You may receive a bill if you receive additional services during the same visit that are not part of the covered Annual Wellness Visit. For example, Medicare.gov explains that additional tests or services, such as a routine physical exam, may create costs if they are not covered under the preventive benefit.
Yes. CMS states that Part B covers an Annual Wellness Visit when performed by a physician, physician assistant, nurse practitioner, clinical nurse specialist, or certain medical professionals or teams under appropriate supervision.
No. The Annual Wellness Visit is a preventive service. You do not need to be sick to complete it. Medicare Part B covers preventive services to help prevent illness or detect health problems early, when treatment is likely to work best.
The Annual Wellness Visit is mainly for prevention planning, risk review, and care coordination. If you have a medical concern that requires diagnosis, treatment, medication changes, or urgent care, the provider may recommend a separate medical visit or direct you to your primary care provider or appropriate care setting.
CMS uses different codes for the first and later Annual Wellness Visits. G0438 is used for the first AWV, and G0439 is used for subsequent AWVs. CMS says these codes may only be billed once in a 12-month period..
Yes. CMS includes review of functional ability and safety as part of the AWV, including activities of daily living, fall risk, hearing impairment, and home and community safety when appropriate.
Yes. CMS says providers check for cognitive impairment as part of the first and subsequent AWV. This may include direct observation or information reported by the patient, family, friends, caregivers, or others.
Yes. CMS says the AWV includes reviewing potential depression risk factors. The provider may use standardized screening tools recognized by medical organizations. Medicare.gov also notes that during a yearly Wellness Visit, patients can talk with their doctor or provider about changes in mental health since the last visit.
Yes. CMS states that Medicare includes an optional physical activity and nutrition risk assessment as part of the AWV. This assessment must follow standardized, evidence-based practices. CMS also states that the deductible and coinsurance are waived once per year when this assessment is billed with the AWV under the required conditions.
Yes, at the patient’s discretion. CMS says advance care planning may be provided during the AWV as an optional element. CMS also says the Part B deductible and coinsurance are waived for advance care planning once per year when it is delivered on the same day by the same AWV provider and billed correctly with the AWV.
No. Medcare is not Medicare, CMS, or a government agency. Medcare provides telehealth services and helps eligible patients complete covered preventive services through qualified health care providers. Medicare coverage rules are set by Medicare and CMS.
No. You should not give your Social Security number or credit card information to anyone calling about a Medicare Annual Wellness Visit. Medcare does not need your credit card to help schedule a covered AWV. If you are ever unsure, hang up and contact Medcare directly using the phone number listed on our official website.
You may receive a notice or call if records indicate that your Annual Wellness Visit status should be verified. The purpose is to help eligible Medicare patients stay current with covered preventive care and avoid gaps in their personalized prevention plan.
If you already completed your Annual Wellness Visit within the last 12 months, you may not be eligible for another one yet. Medicare covers the AWV once every 12 months, and CMS states that AWV codes are limited to once in a 12-month period.
Yes, if you are eligible and the service is provided through an approved telehealth process. CMS states that Medicare pays for AWV codes G0438 and G0439 when provided through telehealth.
The Annual Wellness Visit helps create or update your personalized prevention plan. It can help identify screening needs, health risks, medication concerns, fall risks, mental health concerns, cognitive concerns, and prevention opportunities. Medicare preventive services are designed to help prevent illness or detect health problems early.