How to implement and code Medicare’s Annual Wellness Visit (AWV)
Medicare’s Annual Wellness (AWV) is a way for your practice to keep patients as healthy as possible, and correctly using the AWV code is vital to the process.
What is the Medicare AWV?
The Medicare AWV allows practices to gain information about the patient, including medical and family history, health risks and specific vitals. Not to be confused with a complete physical examination, the purpose of the AWV is to review the patient’s wellness and develop a personalized prevention plan. The services provided during the AWV are different from a typical preventive care visit and expand to include emotional and psychological well-being, in addition to the patient’s physical well-being. The AWV provides an opportunity for physicians to improve the quality of care, assist in patient engagement and optimize payment opportunities.
As health care moves from volume- to value-based models, the AWV addresses gaps in care and enhances the quality of care you deliver. A personalized prevention plan created for the Medicare beneficiary is a way to improve patient engagement and promote preventive health care.
AWV implementation tips
Consider providing AWVs to all Medicare Part B patients.
Use the AWV to identify patients who would benefit from a discussion regarding their self-management goals.
Choose patients the staff has identified as highest risk (i.e., staff are concerned that the patient is unstable or may be more likely to need additional services or have recently been to the ER).
Use this service to risk stratify your patient population.
Use this service to document diagnoses and conditions to accurately reflect patient severity of illness and risk of high-cost care.
G0438
G0438 is the code for the initial AWV. It is used to bill Medicare for the first comprehensive wellness assessment. The submission of G0438 for a beneficiary for which a claim code of G0438 has already been paid will result in a denial.
Selected G0438 requirements and components
Billable for the first AWV only. Patient is eligible after the first 12 months of Medicare coverage. For services within the first 12 months, conduct the Initial Preventive Physical Exam (IPPE), also referred to as the Welcome to Medicare Visit (G0402).
The patient must not have received an IPPE within the past 12 months.
Administer a Health Risk Assessment (HRA) that includes, at a minimum: demographic data, self-assessment of health status, psychosocial and behavioral risks, and activities of daily living (ADLs), instrumental ADLs including but not limited to shopping, housekeeping, managing own medications, and handling finances.
Establish the patient’s medical and family history.
Establish a list of current physicians and providers that are regularly involved in the medical care of the patient.
Obtain blood pressure, height, weight, body mass index or waist circumference, and other measurements, as deemed appropriate.
Assess patient’s cognitive function.
Review risk factors for depression, including current or past experiences with depression or mood disorders.
Review patient’s functional ability and safety based on direct observation, or the use of appropriate screening questions.
Establish a written screening schedule for the individual, such as a checklist for the next 5 to 10 years based on appropriate recommendations.
Establish a list of risk factors and conditions for primary, secondary, or tertiary intervention.
Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
At the patient's discretion, furnish advance care planning services.
G0439
G0439 is the code for any subsequent AWVs.
Selected G0439 requirements and components
The patient cannot have had a prior AWV in the past 12 months.
Update the HRA.
Update the patient’s medical and family history.
Update the current physicians and clinicians that are regularly involved in providing the medical care to the patient, as developed during the initial AWV.
Obtain blood pressure, weight (or waist circumference, if appropriate), and other measurements, as deemed appropriate.
Assess patient’s cognitive function.
Update the written screening schedule checklist established in the initial AWV.
Update the list of risk factors and conditions for which primary, secondary and tertiary interventions are recommended or underway.
Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
At the patient's discretion, the subsequent AWV may also include advance care planning services.
The AWV can be your first step in testing the value-based care waters.
Frequently asked questions about the AWV
AWV FAQs
The Initial Preventive Physical Examination (IPPE)/Welcome to Medicare Preventive Visit is a once per lifetime benefit that may be provided only within the first 12 months of enrollment in Medicare Part B. The AWV is covered only after the first 12 months of Medicare Part B coverage have passed. The AWV can be provided annually once per 12-month period thereafter.
No. The AWV does not replace a complete head-to-toe physical exam. A yearly physical (CPT codes 99381-99397) is not covered by Medicare.
The AWV is covered 100% by Medicare. There is no deductible or coinsurance owed by the patient.
Medicare pays 100% for the AWV and focuses on health promotion and prevention. A problem-oriented visit is not part of this benefit and is subject to deductibles or coinsurance.
Yes. The patient may be asked to complete portions of the IPPE or AWV prior to the appointment, such as demographic information and self-assessment of health status. The AAFP’s FPM journal has several patient surveys and questionnaires for patients and/or your staff to complete.
Better patient care starts with preventive wellness visits. Download the AAFP’s patient flier and use it to talk with your Medicare patients about the importance of scheduling a free, personalized prevention visit with you.
The following health care professionals can perform the AWV:
- A physician who is a doctor of medicine or osteopathy
- Physician assistant
- Nurse practitioner
- Certified clinical nurse specialist
- Medical professional, including a health educator, registered dietitian, nutrition professional or other licensed practitioner, or a team of medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy).
- IPPE – G0402
- EKG/ECG with IPPE – G0403
- Other codes that are applicable – G0404 and G0405
- Initial AWV – G0438 (includes personalized prevention plan of service)
- Subsequent AWV – G0439 (includes personalized prevention plan of service)
Yes. The appropriate E/M service may be billed in addition to the AWV. Report the CPT code with modifier 25. The E/M service is subject to a co-payment.
No. A consent form is not required for this benefit.
The AWV can only be billed once in a 12-month period for a single beneficiary, so only the first provider can be paid for an AWV exam.
Contact your local Medicare Administrative Contractor (MAC) to verify whether the coverage requirements concerning time intervals between services have been met.
If the patient has moved or spent part of the year in another part of the country (e.g., is a “snowbird”), you may also need to contact the MAC for the part of the country where the patient lived previously. You can identify the relevant MAC and their contact information through this interactive map from CMS.
Alternatively, you may want to access the CMS HIPAA Eligibility Transaction System (HETS) Help (270/271), a secure website you can use as your primary Medicare information source for patient eligibility and liability. HETS is available at no cost to you at any time, with limited functionality outside of normal business hours.
Medicare Annual Wellness Visit: Getting Paid for What We Do Best
Review the AWV, identify how findings can close care gaps, and examine financial and quality implications