wellness visit

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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What is an Annual Wellness Visit and Why is it Important?

by Charles Smith, RN, BSN

Annual Wellness Visit

If you or your loved one are 65 years or older,  you may have heard about Medicare’s free benefit called the Annual Wellness Visit.  Here are some things you need to know and what to expect during your Annual Wellness Visit:

What is the Annual Wellness Visit?

The Annual Wellness Visit is NOT a physical. Rather, it is conversation between you and your doctor to discuss your health history and any concerns you may have regarding your health, and to review your medications and immunizations. It also is a time when you and your doctor review your existing health problems; determine what health issues may become a concern in the future and how to prevent them.

The goals of an Annual Wellness Visit are to create a complete personal and family health history and to help prevent future health problems.

What to Bring to Your Annual Wellness Visit

• A list of all of your medications, including vitamins and supplements
• Names of all of your healthcare providers, including doctors, pharmacists, therapists, home health agencies, and non-traditional providers
• Your immunization records, including flu or pneumonia shots

HIPPA laws prevent physicians from sharing information about you with one another without your permission. This is why it is important to bring this information with you to your Annual Wellness Visit, particularly if you see multiple healthcare providers.

What to Expect

The Annual Wellness Visit is performed either by your physician, a nurse or a nurse practitioner. You can expect your provider to discuss with you your health history, medications, healthcare team and immunization schedule. Other components of the Annual Wellness Visit are a Health Risk Assessment, a Wellness Schedule, Advance Directives and a Personal Health Record.

Your Health History

The AWV begins with your doctor collecting your family and personal health history. Your physician may have most of this information, but it is important to provide information that is not in your records to ensure that your health history is correct and complete.

Medication Review

Your doctor will review your list of medications, including those prescribed by other physicians, to ensure that there are no negative interactions. This is a good time to ask questions you may have about your medications.

Your Healthcare Team

Your provider will create a comprehensive list of your healthcare team for future reference.

Immunization Schedule

Your doctor will review your immunizations and determine if you need additional vaccines.

Health Risk Assessment

A Health Risk Assessment includes your weight, height and blood pressure. You will be asked such questions as your ability to care for yourself, your memory, whether or not you are depressed, and your smoking and drinking habits.The purpose is to determine if you are at risk for future illnesses. Once the Health Risk Assessment is completed, your doctor may recommend screenings in the event some concerns arose during the assessment. These screenings will be performed during a separate visit, and possibly with another physician, depending on the type of screening. Your doctor is required to tell you if the screening requires a co-pay.

The Wellness Schedule

Medicare requires physicians to provide a Wellness Schedule to patients during the Annual Wellness Visit. The Wellness Schedule is a list of all of the screenings you should have during the next five-to-10 years. These screenings can include prostate exams, mammograms and heart-related screenings. Many of these are free to the patient.

Advance Directives

While physicians are no longer required to give their patients information on Advance Directives – or Living Wills – you can discuss your wishes with your doctor and ask about the procedures you need to follow to complete an Advance Directive. Your physician should be able to provide a standard form for you to complete.

Personal Health Record

All of the information collected during your Annual Wellness Visit is compiled into one document called a Personal Health Record. You can obtain a copy of your Personal Health Record from your physician. It is a great tool to use when you have to go to the hospital, see other doctors, or visit small clinics. Since healthcare providers are not allowed to discuss your health situation with other providers, the Personal Health Record helps ensure that all of your healthcare providers have your complete health history.

It also can be very helpful to your adult children to have a copy of your Personal Health Record in the event they need to represent you at the hospital or emergency room.

Be Your Own Advocate

The Annual Wellness Visit gives you and your doctor a complete picture of your health and what you need to do to be healthier. The more you know about your health, the more likely you are to be your own advocate. So, schedule your Annual Wellness Visit, have a great conversation with your doctor and stay healthy.

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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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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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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.

Your Annual Wellness Visit: What to Expect

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Your annual preventive health exam (aka well visit or annual physical) is scheduled with your primary care physician to catch potential health issues early, before they become serious, and to help you focus on wellness and a healthy lifestyle while identifying important screening tests, vaccinations and other necessary testing.    

Most insurance plans cover your annual wellness exam—no copay required. However, says Dr. Adam Stracher , Chief Medical Officer , Director of the Primary Care Division and Associate Dean at Weill Cornell Medicine, you may find the actual components of a wellness visit a bit confusing .

Read on for answers to your FAQs—and learn what to expect when you visit your doctor’s office, in times of sickness and in health. 

What is included in a wellness visit?  

Your annual wellness visit includes the following:

• A review of your medical and surgical history  
• Screenings  
• Blood tests  
• Immunizations  
• A physical exam  
• Counseling to prevent future health problems    

How should I prepare for my visit?  

“ You can check in via Connect   up to 5 days before your visit to make sure we have your most up-to-date information , including your medications, medical history and insurance. You will be able to update these, along with your preferred pharmacy . And you can also review and update your responses to your health questionnaire ,” Dr. Stracher says.    

Please fast for at least 4 hours prior to your visit. You may drink water or black coffee, and take your maintenance medications.  

On the day of your appointment, please arrive on time and bring your insurance card and ID.  

What if I need to ask my doctor about a specific medical issue?  

Specific issues, whether raised by you or identified by your physician during the visit, are considered part of a follow-up or “sick” visit, he explains. “These aspects of your visit will be billed to your insurance, and you may be responsible for copayments, coinsurance or deductible payments, based on the terms of your policy. If you would like to address non-routine concerns during your wellness visit,” he adds, “let us know about these issues when you schedule your appointment. Depending on their complexity, we may need to deal with them at a later time."   

What does a follow-up or “sick” visit include?  

• Treatment of a chronic condition such as diabetes, asthma or high blood pressure  
• Any new problems or complaints  
• Your need for new medications or tests  
• Referrals to a specialist  
• Additional treatment options  

What is a Medicare annual wellness visit and what does it include?  

The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.  

Your Medicare wellness visit does not include a detailed physical exam or management of chronic or new medical problems. Your physician may be able to perform a complete physical and address new or existing medical issues during your Medicare annual wellness visit, but you could incur additional charges.  

What to expect during your Medicare a nnual w ellness v isit  

At your Medicare annual wellness visit, y our health care provider will :  

• Review your blood pressure, heart rate, height, weight and body mass index (BMI).  
• Review your current health problems, as well as your medical, surgical, family and social histories.  
• Review your current medications.  
• Conduct a health risk assessment.  
• Provide nutrition counseling.  
• Discuss an exercise plan to fit your lifestyle.  
• Discuss smoking cessation and arrange for counseling, if needed.  
• Discuss fall prevention.  
• Discuss advance care planning.  
• Discuss preventive screenings recommended by evidence-based practice guidelines that are indicated for you based upon your age, risk factors and family history

How t o p repare for your Medicare wellness visit  

Bring these items to your visit:  

• Immunization records  
• A list of current prescribed medicines, supplements and over-the-counter medications  
• A list of your patient care team—any specialists you see for various types of care  
• Be prepared to review your family medical history.  

Can I combine a Medicare or non-Medicare wellness visit with a physical exam?  

Combining a wellness visit with a physical or follow-up office visit will save you time by eliminating an extra appointment, but doing so may affect your costs. Additional concerns beyond a wellness visit may be billed to your insurance, which can result in unplanned out-of-pocket costs to you. For these reasons, Weill Cornell Medicine Primary Care recommends that you schedule your annual wellness visit and any follow-up or sick office visits separately.  

What are the most important points I need to keep in mind?  

• Review your insurance plan’s summary of benefits before your appointment to understand what your insurance company will or will not cover.  
• When scheduling a wellness visit, clearly state that you would like to make an appointment for your annual wellness or preventive care exam. That will help the practice prepare for your visit and bill your insurance company appropriately.  
• When you speak with your doctor or other practitioner, let them know you are there for a wellness exam. Or, if you need to discuss a specific concern that may require treatment, make sure to bring their attention to any non-routine concerns at the start of your appointment.  

You can schedule your annual wellness or follow-up office visit with a provider in Primary Care  .

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Your annual wellness visit: 4 things to know

When you’re feeling fine, you may be tempted to skip an annual wellness visit. But going to a primary care provider when you’re feeling healthy may be the best time to schedule this yearly exam.

An annual wellness visit gives providers and patients a chance to talk about how lifestyle steps such as diet and exercise can help prevent and treat diseases, says Michael Hochman, M.D., M.P.H., a physician in Los Angeles and the host of the Healthy Skeptic, MD podcast. 

Since you’ll have the provider’s full attention, make the most of the appointment. Here are four ways to do just that.

1. Prepare for the visit ahead of time

Getting organized before arriving means having more time to discuss overall health with the provider. Here are four things to bring to the appointment, says Dr. Hochman:

• A list of all medications. This includes any prescription drugs, over-the-counter medications and vitamins and supplements. After all, almost a quarter of all adults aged 40 to 79 take 5 or more prescription drugs. 1 It’s worth going through the list with the provider to see which ones may not be needed anymore, says Dr. Hochman.
• A list of everyone on your care team. Bring the names and contact information of any other health care professionals or specialists. Don’t forget to add caregivers to the list, too. It will help the primary care provider coordinate your overall care.
• Health highlights. It can be helpful to bring a list of any significant health milestones to the visit too.
• A list of questions. If you have any health concerns you want to discuss, now is the time to do it. When you’re caught up in the moment, it’s easy to forget what you wanted to ask – a list ensures everything is addressed.

2</sup>">2. Expect a thorough review of your health 2

On arrival to the visit, you’ll fill out a list of questions that the provider uses to better understand your overall health. It helps them identify any health risk factors, such as whether you smoke or have a family history of a certain disease. The answers help the provider create a prevention plan that may help you get healthier.

They will also run some basic tests and ask additional questions. A visit may include: 

• Checking height, weight and blood pressure
• Reviewing your medical and family health history, including specialists you’ve seen in the past year
• Talking about necessary preventive screenings, such as a mammogram or a colonoscopy 3
• Discussing any medications you may take
• Providing personalized health advice (that may include nutrition counseling, a fitness plan, help cutting back on alcohol, etc.)
• Looking for signs of mental health or cognitive problems. They may check to see if you’re feeling sad or blue or having difficulty sleeping. They may also discuss any challenges you have with memory, or if you’re finding it hard to learn new tasks or manage your finances. If the provider thinks there may be problems, they may schedule another visit for a more thorough review.

3. There will be time to ask questions

Going over your health in the past year only takes up part of the time you spend with the provider. You will have time to talk about your concerns too. That’s also a good opportunity to get to know the health provider a little better.

“We allow a bit more time for an annual wellness visit, so it’s great to engage and get to know your doctor, so that you’ll feel more connected if you develop a health problem later,” explains Dr. Hochman.

However, you should be aware that if you discuss a specific health problem, you may be billed for the annual wellness visit and a specific care visit. “They’ll both be billed to your insurance, and you may be responsible for a copayment, depending on the plan,” explains Dr. Hochman. If you have health issues that are complicated, you may want to schedule a follow-up visit to discuss those.

2</sup>">4. End the visit with a plan 2

After talking about overall health goals, the provider will work with you to create a roadmap for the year. Sometimes it’s hard to remember everything you heard during the exam. The good news is that the provider has been taking notes.

To make sure you understand what was discussed during the visit, ask for a copy. The notes may also include when and where to schedule screening tests. If you had any tests during your appointment, ask when to expect results and how they’ll be communicated.

There may be a need to schedule follow-up care, especially if there are health issues such as diabetes, kidney problems or heart disease. If you have a chronic condition, the provider may refer you to a specialist for further treatment. 

Annual wellness visits help providers catch problems early, while they’re still treatable. So they’re key to helping you get healthier — this year and in the future. That’s why it makes sense to schedule the annual wellness visit today, even if you feel fine.

Getting routine care, tests and treatments are important to your health. Schedule an annual wellness visit today. Already a UnitedHealthcare Medicare Advantage member? Sign in to your plan website to see if you’re eligible to earn rewards for completing an annual wellness visit.

• Medicare Advantage
• Dual Special Needs Plan

Already a UnitedHealthcare® Medicare Advantage member?

Getting routine care is important to help live healthier. You may be eligible to earn rewards for completing an annual wellness visit.

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