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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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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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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

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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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Does Medicare Cover Annual Wellness Visits?

Yearly visits with your primary care physician serve as an integral part of health maintenance. Early detection and treatment of medical concerns can often prevent illnesses from progressing or leading to more serious complications.

Importance of Preventive Care

Monitoring your health on a yearly basis allows you and you doctor to record important vital health information. Keeping track of changes may help identify or predict health needs at a later date, especially as you age. Taking the appropriate steps to manage your health before you experience symptoms can delay complications, reverse the effects of chronic disease or prevent debilitating conditions from ever occurring.

Aside from yearly doctor’s visits to evaluate the status of your overall health and wellness, you may discuss lifestyle choices and get help making changes in tobacco use, frequent alcohol drinking consumption, or excessive intake of sugary or processed foods. Monitoring these habits carefully can reduce your risk of developing certain cancers, high cholesterol, diabetes, liver and kidney diseases and cardiovascular issues.

Your doctor may also advise you to exercise and may help you devise a personal exercise program that suits your mobility needs and personal goals. Additionally, health care professionals agree that sleep habits and activities that stimulate critical thinking skills also improve wellness and longevity.

Annual Physicals vs. Annual Wellness Visits – What’s the Difference?

Although many people assume an annual physical and annual wellness visit are the same thing, there are key differences between these two types of visits that you should understand as a Medicare recipient.

Both an annual physical and an annual wellness visit will involve measuring your height and weight as well as your blood pressure and body-mass index (BMI). Your doctor will also consult with you about any current medical conditions and those that are present in your family history. This may include discussing any medications or treatments you’ve received. An assessment of risk factors may also be performed in either visit.

In an annual physical, a doctor may examine your vital signs, head, neck, lungs and abdomen. They may also perform a neurological exam or a reflex test. Samples of urine and blood may be taken for further testing with a lab.

An annual wellness visit does not include these exams and tests, although the doctor may schedule a separate appointment or refer you to a specialist if they suspect underlying medical conditions that need more examination. They will also establish a schedule for necessary screenings during a wellness visit.

Medicare Coverage for Annual Wellness Visits

During your first 12 months as a recipient of Medicare benefits through Medicare Part B, you qualify for a one-time preventive visit known as your Welcome to Medicare visit. This is meant to establish the baseline for all future wellness visits with your primary care physician. When performed by a participating provider, this Welcome to Medicare visit is fully covered by your Medicare Part B benefits.

Annual wellness visits are also fully covered once every 12 months when provided by a physician who accepts assignment through your Medicare benefits. If your physician determines you need additional diagnostic screenings during your Welcome to Medicare visit or your annual wellness visits, you will be responsible for any cost-sharing obligations associated with these services under Part B.

Recipients who are eligible for both Medicare and Medicaid may be enrolled in savings programs that cover out-of-pocket expenses or enhance the type of health care services they can access. Eligibility for these programs are determined by needs-based rules that evaluate financial requirements and medical necessity. Your state’s Medicaid office will have information about application rules.

Medicare Supplemental plans, also known as Medigap plans, may also help reduce your out-of-pocket expenses when it comes to certain deductibles, coinsurance or copayment amounts. Medicare Advantage plans can also offer cost-sharing reductions as well as extra benefits, such as routine vision and dental care. These plans are offered through private insurance carriers and may not be available in all locations.

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How to Get More Out of the Medicare Annual Wellness Visit

Are you taking advantage of Medicare’s free Annual Wellness Visit (AWV)? The AWV allows you and your provider to focus on key areas for staying well: disease prevention and detection and health promotion.

If you’re new to the AWV, you may have questions about what it includes and how we can further meet your needs.

What does the Annual Wellness Visit include?

“An AWV is a tool clinicians use to assess a patient’s overall health,” says Summit Health Vice-Chair of Primary Care in New Jersey, Jill Hup, MD . “It is meant to measure how well a patient can perform their daily activities and help keep them up to date with preventative screenings and vaccinations.”

Your AWV may include:

• A review of your medical, surgical, and family history
• Measurements of your height, weight, and blood pressure
• Assessments for depression, fall risk, and memory problems
• A review of your prescriptions and over-the-counter drugs for possible interactions
• Recommendations for immunizations, such as the flu or pneumonia shots, and health screenings for cancer, such as colonoscopy or mammogram
• A written preventive plan that outlines next steps for continued wellness
• Advance care planning as appropriate

Medicare covers one AWV a year, so schedule accordingly. For example, if you schedule an AWV in May of this year, the soonest you can come in for your next one would be May of next year.

Doesn’t my provider review my medical history, measurements, and prescriptions during my other visits?

Yes, your provider reviews this information at every visit; however, the AWV goes further.

The AWV allows time to assess your overall health and wellness holistically. This means that in addition to regularly reviewed information, your provider works with you to develop a wellness plan inclusive of all your screenings, immunizations, risk factors, personal history, and other preventive recommendations.

The reason that Medicare recommends the AWV is because it has been proven to keep patients healthy. Patients within our group who have AWVs every year complete more of their recommended screenings. They also have better control of their chronic conditions and fewer subsequent illnesses.

Does the AWV include a physical exam?

While the AWV is a valuable component of preventive care, it does not include a physical exam or address active medical problems. “We know this general view of wellness does not tell the whole story,” notes Dr. Hup. “Many of our patients live with chronic medical conditions like hypertension, diabetes, obesity, and depression that require close monitoring. Therefore, we offer a  Comprehensive Care Visit (CCV)  to ensure all medical issues are addressed at the time of the AWV. We want to educate patients about their disease, recommend treatment strategies to get their condition under good control, and provide encouragement and guidance along the way to enable them to live their very best life,” she adds.

A CCV includes all the AWV’s preventive services plus:

• A physical exam
• Management of acute and/or chronic conditions, including back pain, allergies, difficulty sleeping, mental health concerns, diabetes, high blood pressure, arthritis, or heart palpitations
• Referrals for laboratory or imaging tests as needed
• Follow-up with a specialty physician if required

Incorporating a CCV into your health care is a good idea, even if you’ve had a physical exam in the past.

“In primary care throughout Westmed Medical Group and Summit Health, we believe in providing comprehensive, lifelong care for patients,” says  Nicholas L. Pantaleo, MD , Chief of Internal Medicine at Westmed Medical Group, a Summit Health Company. “Therefore, if you are having any additional issues such as joint pain or are in need of blood pressure monitoring—even though this is not covered with the AWV—our providers will gladly address these new or chronic care concerns and even perform a physical exam.”

When you add a CCV to the AWV, you are only responsible for a copayment or coinsurance like any other visit to the doctor. Some Medicare Advantage plans cover a physical exam and the AWV.

I’ve been asked to come in for a blood draw before my AWV or CCV. Will it be covered?

The AWV does not include routine blood tests; however, to save you time and offer more comprehensive care, your provider may combine the AWV with your routine follow-up visit and may request blood tests. Lab tests are covered under your Medicare benefits based on the medical diagnosis associated with the orders. A patient may be responsible for the copayment/coinsurance as with other tests.  

Primary care is essential to better overall health

Primary care providers are the cornerstones of patient care, particularly in adults age 65 and older. Research shows that people who have an ongoing relationship with a primary care provider and get their recommended screenings and immunizations have better overall health and lower mortality rates.

“We strongly believe in caring for the whole person and in addressing all of your health care needs, including acute issues, and chronic conditions,” says internal medicine physician and Chief Quality Officer  Ashish Parikh, MD . “Preventive medicine saves lives. “Even if you’re in generally good health for someone over 65, you may not realize that your blood pressure is high, a medication has an interaction, or you are overdue for an eye exam. That’s why we encourage all our Medicare patients to make sure they have their AWV every year, whether they see their providers only once a year or come in often for follow-up visits.” 

If your primary care physician isn’t available when you want to come in for an AWV, another provider can step in to keep you on track. All our providers use a shared medical record system, so your primary care physician will be able to access information after your visit. The provider who covered your visit will communicate any recommendations, as well.

If you do not have a primary care provider, we will  find one for you .  

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What Is Not Covered by a Medicare Annual Wellness Visit?

Medicare's Annual Wellness Visits (AWVs) play a pivotal role in proactive care management , but patients often don’t understand what these visits entail and, equally importantly, what they don’t cover. 

Patients and providers alike must recognize that AWVs primarily focus on preventive services and wellness planning rather than serving as a platform for addressing acute medical concerns or providing diagnostic tests.

AWVs allow patients to engage in comprehensive discussions with their healthcare providers, review their individual risks and medical history, and develop a personalized prevention plan. Properly administered AWVs can improve patients' quality of life and clinical outcomes. 

Patients often confuse these annual check-ups with their yearly physical exams, yet the two appointments vary in their procedures and intended outcomes. 

In this article, we will explore what is not covered by Medicare's AWVs, the importance of comprehensive healthcare planning beyond routine wellness visits, and how to integrate AWVs into your practice’s workflow by implementing AWV software.

What is the purpose of a Medicare Annual Wellness Visit? 

Medicare’s Annual Wellness Visits (AWVs) are used to develop proactive and preventative wellness plans by observing a patient’s risk factors , family medical history, and current health status. AWVs can identify and eliminate gaps in care , potentially preventing disease, injury, and disability. They are also part of Medicare’s broader strategy to shift the healthcare landscape from traditional fee-for-service models to value-based care , emphasizing quality, efficacy, and respect for patient preferences.

The ultimate goal of AWVs is to actively engage patients in their healthcare and facilitate better clinical outcomes. This service provides a wellness roadmap that mitigates long-term risks of developing or worsening chronic illnesses. 

The purpose of an AWV is not to treat previously existing healthcare diagnoses, review medications, or discuss newly emergent patient concerns, although an AWV can be added to a visit focused on these other needs. But the main goal of AWVs is to provide an intentionally broad picture of a patient’s baseline health, which is then leveraged to plan proactive care and catch potentially serious health issues before they can develop into debilitating conditions. 

AWVs are fully covered by Medicare. Once a patient has been enrolled in Medicare Part B for over a year, they are eligible to receive an AWV once every twelve months. If they’ve been enrolled in Medicare for less than a year, they can receive a “Welcome to Medicare” visit instead. 

Learn more: The Ultimate Guide to Medicare Annual Wellness Visits . 

What is covered by a Medicare Annual Wellness Visit?

An AWV may include the following: 

• The administration of a Health Risk Assessment (HRA)
• Assessment of a patient’s familial medical history
• Measurement of height, weight, and blood pressure
• Evaluation of cognitive function
• Risk factor identification 
• Functional ability assessment
• Behavioral health screenings
• Advance Care Planning
• The creation of a personalized care plan that aims to reduce risk factors, close gaps in care, and promote optimal quality of life for each patient

What is not covered by a Medicare Annual Wellness Visit? 

Medicare’s AWVs do not cover: 

Physical examinations

• Vaccinations
• Medication prescription or adjustment
• Chronic illness treatment
• Sick visits
• Diagnosis of conditions 
• Any type of bloodwork, lab tests or panels, or X-rays

AWVs are not meant to treat or discuss pre-existing conditions or diagnose new or developing conditions. Those services are provided by regular provider visits. An AWV has preventative, holistic goals, as outlined by Medicare and CMS (Centers for Medicare and Medicaid Services). That said, an AWV can be combined with a regular visit to receive care for a chronic condition. But the care for the chronic condition will be billed separately, not counted as part of the AWV. 

Annual physical examinations are routine medical visits familiar to most patients. These often consist of the collection of vital signs like temperature, heart rate, blood pressure, and BMI (Body Mass Index). Physical examinations may also include bloodwork, urinalysis, visual examinations for moles and lesions, vision acuity, and a general assessment of organ functionality. 

Physical exams help providers understand a patient’s current health conditions, whereas AWVs are designed to improve overall health by taking a broad, holistic view of a patient’s history and risk factors. 

For example, in an annual physical, a provider searches for warning signs of melanoma on an individual’s body. During an AWV, a provider would ask the patient questions to determine the potential risk for familial melanoma. Both are crucial to the patient’s current and lasting health prospects, but they differ in execution and are seen as distinct services by Medicare. 

Many patients conflate an AWV with their yearly physical. This misunderstanding is one of the most common points of confusion around the AWV service and often leads to patient frustration and dissatisfaction. Practices and providers alike must create clear, specific messaging that delineates the two appointments as distinct and separate services. 

While AWVs and annual physicals are complementary and both provide critical insight into a patient’s health, an AWV does not consist of the physical examination of a patient. If a healthcare provider does administer physical examinations during the AWV, those will need to be billed separately. 

Learn more: The difference between Annual Wellness Visits and Annual Physical Examinations

Bloodwork, X-rays, and lab tests

Bloodwork, X-rays, lab tests, and any other medical biometric data collection are explicitly not covered under Medicare’s Annual Wellness Visit. These ancillary procedures are often performed in conjunction with an annual physical or a sick visit. They help the healthcare provider assemble a robust picture of a patient’s physical health, identify the root cause of a patient’s health issues, and evaluate the success of current medications and treatments.   

None of these fall within Medicare’s stated vision for the AWV, and a patient will be charged for these services separately. However, in the course of an AWV, it is very likely a provider may identify missing screenings or panels in a patient’s medical history. They may subsequently perform these procedures themselves or refer the patient to a specialist. Since these procedures fall beyond the scope of the AWV, the provider should warn the patient that they may be responsible for copays and deductibles.  

For example, suppose a patient reveals a history of diabetes in their family. In that case, a provider may wish to perform blood work like an A1C test to assure the patient is not prediabetic or otherwise at risk. However, that process will need to be billed separately from the AWV. The purpose of the AWV is to gather information about a patient’s health, identify relevant gaps in care, and chart a proactive, preventative care plan. An AWV is not meant to ascertain if the patient is diabetic at that moment–that’s a separate test. 

Treatments for chronic illness 

Medicare does not cover Annual Wellness Visits if they are used to discuss, plan, or alter treatment for pre-diagnosed chronic illnesses, including high cholesterol, high blood pressure, or arthritis. This includes lab work, medication prescriptions or adjustments, evaluation of treatment plans, or discussion of chronic illness management. These discussions will need to take place separately from the AWV. 

During an Annual Wellness Visit, healthcare providers will assess a patient’s medical history, chronic illness diagnoses, and prescribed medications to establish a comprehensive understanding of the patient’s health. 

However, AWVs are not designed to address illnesses previously diagnosed by healthcare providers. Patients should already be engaged in treatment plans for these conditions and in regular communication with providers, specialists, and care managers about their progress and concerns. Preventative care programs like Chronic Care Management can help with this. An AWV, on the other hand, is more holistic. 

The AWV aims to create proactive care plans, and if the appointment becomes dominated by discussing previously diagnosed illnesses, there is little time to look forward and meaningfully plan for the future. Therefore, if chronic illness treatment is discussed during an AWV, the patient will be charged a copay and/or deductible for the separate service.

Treatments for new illnesses and sick visits

Annual Wellness Visits should not be used to diagnose new conditions, prescribe new medications, or treat any sort of infection, injury, or discomfort. If a patient is experiencing pain or distressing symptoms, they should schedule a dedicated sick visit with their provider. In a sick visit, a physician can take the time to evaluate and treat these concerns properly. Some providers may choose to include an AWV before or after a sick-care visit, but they are separate services. 

Wellness visits are holistic by design. Time spent discussing a specific injury or illness detracts from the long-term wellness planning the AWV intends to facilitate. While the illnesses and injuries a patient experiences will factor into their future health and wellness goals, the actual treatment of these conditions is a separate service. 

Learn more: The Ultimate Medicare Annual Wellness Visit Checklist for Providers 

Why are these services not covered by an Annual Wellness Visit?

Medicare Annual Wellness Visits focus intentionally on preventative care and creating a roadmap for optimal long-term patient health. Focusing on pre-existing chronic conditions, injuries, or physical examinations and concerns could potentially hinder a provider’s ability to devote the necessary attention to holistic, futuristic wellness planning. Therefore, Medicare clearly distinguishes between AWVs and other routine appointments, offering narrow coverage to encourage patients and providers to take advantage of the often-underutilized AWV service. 

Should your practice offer out-of-coverage services during an Annual Wellness Visit?

Ultimately, whether non-covered services are offered during a scheduled AWV is up to the individual discretion of a practice. Providers can offer services that fall outside the scope of an AWV during the appointment, though these will need to be billed separately and result in payment by the patient. Therefore, it is crucial to master clear and effective messaging to patients around expectations and coverage before the appointment. 

Some patients prefer to combine their AWV with topics not covered under their insurance plan rather than schedule a separate appointment. Other patients may prefer to strictly stick with the stated purview of the AWV and avoid extraneous or unexpected charges.  

Encourage patients to contact their insurance providers with any further questions about what is covered and what their coinsurance or copayments will be. This eliminates confusion and frustration, improves communication between providers and patients, and facilitates higher patient satisfaction. 

If your practice uses AWV software, like ChartSpan’s proprietary RapidAWV™ , combining wellness visits with sick visits, medication refills, or other standard appointments may be easier. With RapidAWV™, patients can complete the preliminary Health Risk Assessments (HRAs) on an iPad, desktop, or mobile device from the comfort of the waiting room. This creates a frictionless integration of the AWV into both the practice workflow and the patient’s appointment. However, your office should communicate clearly with the patient beforehand about the limitations of coverage to establish proper expectations. 

How to correctly bill Annual Wellness Visits

AWVs can be performed by a variety of healthcare professionals. Specialists like neurologists and cardiologists, primary care physicians, nurse practitioners, physician assistants, and dieticians are just some of the healthcare workers who can perform AWVs and subsequently bill these appointments to Medicare. 

However, Medicare patients are only eligible to be reimbursed for one AWV per twelve-month calendar year. If your patient’s cardiologist billed CMS for an AWV last month, your claim will be denied if you try to submit a reimbursement for the same service. Therefore, real-time eligibility checks within the HIPAA Eligibility Transaction System (HETS) database are crucial to the success of your AWV enterprises. AWV software, like RapidAWV™, offers up-to-date identification of eligible patients. This technology ensures your practice does not face coverage denials and any resulting complications. 

It is also essential that your practice employ the correct AWV CPT codes when billing CMS for these services. CPT codes differ based on distinct phases within the AWV program. Ensuring your team understands the distinctions between each code will help streamline billing processes and safeguard your practice against reimbursement rejections. 

Seamlessly implement AWVs with ChartSpan’s industry-leading RapidAWV™ software

The challenge with AWVs: AWVs remain an underused resource within the healthcare space despite studies demonstrating that they are correlated with reduced hospitalizations and readmissions, lower healthcare costs, and increased usage of preventative services. Over 80% of eligible Medicare recipients do not take advantage of these annual wellness planning sessions. 

Furthermore, practices create an additional source of recurring revenue when they integrate AWVs into their clinical workflow. The administration of AWVs can net practices between $118-174 in reimbursements per visit*. When paired with other preventative services, like obesity or smoking cessation consultations, these reimbursements can be even higher. 

Integrating a new service into your practice’s workflow can be cumbersome and time-consuming, especially one as misunderstood as Medicare’s AWV program. If patients do not understand the purpose or scope of AWVs, they are unlikely to take advantage of them. This can be all the more frustrating for your practice if you devote significant internal resources to creating an AWV program that patients find too complicated or confusing to use. 

*Results may vary by provider. 

ChartSpan’s solution: Streamline your practice’s administration of AWVs through ChartSpan’s RapidAWV™ software. The customizable HRAs generate preventative care plans personalized to every patient’s needs, risks, and lifestyle factors. Our software then presents you with 5 to 10-year care plans to share with patients. 

Our RapidAWV™ software is compatible with various devices, including desktops, tablets, and mobile phones. The Health Risk Assessments are designed to be senior-friendly and easy to complete. Whether the patient is there exclusively to receive an AWV or is pairing it with another appointment, these HRAs expedite the process without sacrificing the integrity or quality of the care provided to the patient.

With real-time eligibility checks against CMS’s HETS database, RapidAWV™ ensures reimbursement for every AWV administered by your practice, eliminating redundancies for your patients, simplifying your practice workflow, and preserving the added revenue stream. Our trained team of clinical professionals will assist you and your staff throughout the integration, ensuring that your team is confident with the new processes.  

Speak with an expert to learn more about how ChartSpan can help your practice improve clinical outcomes and capture additional revenue through the frictionless implementation of our industry-leading AWV software. 

You may also like: 

• The Benefits of Annual Wellness Visits
• 7 Challenges in Delivering High-Quality Care to Patients with Chronic Conditions 
• Patient-Centered Care Explained

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Proactively address patient health with preventive care programs that provide more revenue for your practice and more personalized care for your patients..

Impress Your ACO with Higher AWV Completion Rates

Discover how Dr. Gigi Davis’s practice used RapidAWV to automate their patient eligibility process, raise their AWV completion rate to 76%, and become the number-one performer of AWVs in their ACO.

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Three steps to coding for Medicare wellness visits

To ensure that your coding and documentation accurately capture the significant relative value units (RVUs) and revenue associated with Medicare wellness visits, follow these three steps:

1. Code for the wellness visit. An initial preventive physical exam (IPPE, or Welcome to Medicare visit) is a one-time physical exam performed within the first 12 months of a patient’s Part-B enrollment. An initial annual wellness visit (G0438) can be provided 12 months after the patient first enrolled or 12 months after he or she received the IPPE. A subsequent annual wellness visit (G0439) can then be provided annually. Each has its own documentation requirements.

2. Code for any additional separately billable preventive services you provided. A list of these services, including information about coinsurance and deductible requirements, is available here . Be aware that some have time requirements (e.g., several separately reportable behavioral counseling codes require at least 15 minutes).

3. Append modifiers as needed to avoid bundling. If you provide advance care planning in addition to an annual wellness visit (it is not billable with the IPPE), append modifier 33 to the advance care planning code. Check with your Medicare contractor to learn what they require.

Read the full FPM article: “ Medicare Wellness Visits: Reassessing Their Value to Your Patients and Your Practice .”

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