The Complete Medicare Annual Wellness Visit Checklist

In this article, find a medicare annual wellness visit checklist along with billing codes and tips.

What Is the Medicare Annual Wellness Visit?

The Medicare Annual Wellness Visit (AWV), or PPPS visit, is a preventive service visit that Medicare enrollees have with their provider each year. It’s covered under Medicare Part B. It provides Personal Prevention Plan Services (PPPS). The goal is to promote enrollee health and disease prevention by developing or updating a Personalized Prevention Plan (PPP) and doing a Health Risk Assessment (HRA) each year.

The AWS is different from the Initial Preventive Physical Examination (IPPE) Medicare or Welcome to Medicare preventive visit, which is available to new Medicare beneficiaries during their first year of enrollment.

Who Can Perform a Medicare Annual Wellness Visit?

• Physician — a doctor of medicine or osteopathy
• Qualified non-physician practitioner (NPP) — a physician assistant /associate (PA), nurse practitioner (NP), or certified clinical nurse specialist (CNS)
• Other medical professional, such as a health educator, registered dietitian, nutrition professional, or other licensed practitioner, or a team of medical professionals supervised by a physician

What Does Medicare Cover for the Exam?

Medicare covers one AWV every 12 months under G0439 or G0438 for the very first exam. 

Patients don’t usually pay anything, including coinsurance or a deductible, for their AWV, and the provider bills the visit as an AWV. The exception is if new medical problems are addressed during the visit.

Why the Medicare Annual Wellness Visit Matters

The annual wellness visit is different from a typical physical exam or other preventative care visit. It expands more on a patient’s emotional and psychological well-being, the physical portion is optional. It’s an opportunity to improve the patient’s quality of care, engage the patient, and optimize payment opportunities.

As part of the visit, providers can use the collected information to analyze risk factors, recommend appropriate preventative services, and most importantly create a unique prevention plan.

Medicare Annual Wellness Visit Checklist — What’s Included

During (or before) annual wellness visits, the primary care provider has the patient fill out a questionnaire called a health risk assessment (HRA). The goal of the HRA is to prevent future health risks and complications by documenting or discussing patient demographics, health status self-assessment, and: 

• Psychosocial risks, for example depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue
• Behavioral risks, such as tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, and driving and home safety
• Activities of daily living (ADLs), including dressing, feeding, toileting, bathing, grooming, physical ambulation including balance and the risk of falls
• Instrumental activities of daily living (IADLs), including using the phone, preparing food, keeping house, laundry, transportation, shopping, managing medications, and handling finances
• Patient medical history
• Height, weight, blood pressure, and other measures as needed.
• Cognitive impairment risk assessment
• Medical screening needs and risk factors
• The patient’s Personalized Prevention Plan Services
• Advanced care planning if the patient wants it
• Current opioid prescriptions and assessment for opioid use disorder (OUD) if applicable 
• Substance use disorders (SUDs)
• Social Determinants of Health (SDOH) assessment

Components of the first AWV and repeat (subsequent) visits are similar, but instead of creating  items, in repeat visits they’re updated, such as for screening needs, an initial schedule is created. And a few items are required only as part of the first visit. Below, find a detailed checklist for both initial AWV and subsequent visits. 

The Patient’s Annual Medicare Wellness Visit Checklist

To help patients prepare for their AWV, ask them to bring the following to their appointment or collect them through your patient portal in advance. 

• Medical records, including immunization history
• Family health history
• Current medications and supplements
• Current health providers and suppliers

14-Point Initial Medicare Annual Wellness Visit Checklist

This checklist list applies to the first AWV for a patient. While the components of the initial and later visits are similar, they’re different enough that the complete list for each is included here. Jump straight to the checklist for repeat AWV visits.

1. Perform health risk assessment or have the patient answer the assessment in advance
   • Complete the HRA before or during the AWV; it shouldn’t take more than 20 minutes. At a minimum, collect information about demographics, psychosocial risks, behavioral risks, ADLs, and IADLs. 
   • Find a sample HRA on page 43 of the Framework for Patient-Centered Health Risk Assessments.

2. Establish patient’s medical and family history, including:

• Medical events of the patient’s parents, siblings, and children including hereditary conditions that place them at increased risk
• Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments
• Use of, or exposure to, medications and supplements,such as calcium and vitamins

3. Document the patient’s current providers and suppliers that regularly provide medical care, including behavioral health providers

4. Measure patient’s:

• Height
• Weight or waist circumference, if appropriate
• Blood pressure
• Other routine measurements you feel are appropriate based on medical and family history

5. Cognitive assessment

• Observe the patient and consider information provided by the patient, family, friends, caregivers, etc.
• Consider using a cognitive test, health disparities, chronic conditions, and other factors that contribute to cognitive impairment risk

6. Review patient’s potential depression risk factors, including current or past  depression and/or mood disorders. Use your choice of standardized screening tools recognized by national professional medical organizations.

7. Review patient’s functional ability and level of safety

• Observe the patient or use screening questions or standardized questionnaires recognized by national professional medical organizations to review, at at least the patient’s:
  • Ability to perform activities of daily living (ADLs)
  • Fall risk
  • Hearing impairment
  • Home and driving safety

8. Create a screening schedule for patients. Covers the next 5–10 years, include immunizations, and base it on the U.S. Preventive Services Task Force and ACIP recommendations

9. Document the patient’s risk factors and conditions with recommended or current primary, secondary, or tertiary interventions , for:

• Mental health conditions, such as depression, and cognitive impairment substance use disorder(s)
• Risk factors or conditions identified during the patient’s initial preventive physical exam (IPPE)
• Treatment options and the related risks and benefits

10. Give the patient personalized advice and referrals to health education or preventive counseling services or programs for lifestyle interventions that can reduce health risks and promote self-management and wellness if needed, such as for:

• Fall prevention
• Nutrition
• Physical activity
• Tobacco-use cessation
• Weight loss
• Cognition

11. Provide advance care planning (ACP) services if the patient wants

12. Review the patient’s current opioid prescriptions and assess for opioid use disorder (OUD) risk factors. Suggest non-opioid treatment options and refer the patient to a specialist if needed. 

13. Screen for potential substance use disorders (SUDs)

14. Assess the patient for Social Determinants of Health (SDOH) (optional)

12-Point Repeat Medicare Annual Wellness Visits Checklist

1. Perform health risk assessment or have the patient answer the assessment in advance

• Complete the HRA before or during the AWV; it shouldn’t take more than 20 minutes. At a minimum, collect information about demographics, psychosocial risks, behavioral risks, ADLs, and IADLs. 

2. Update the patient’s medical and family history, as needed, including:

• Medical events of the patient’s parents, siblings, and children including hereditary conditions that place them at increased risk
• Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments
• Use of, or exposure to, medications and supplements, including calcium and vitamins

3. Review the patient’s list of the current providers and suppliers that regularly provide medical care, including behavioral health care; update if needed

4. Measure patient’s:

• Weight (or waist circumference) and blood pressure
• Other routine measurements you feel are appropriate based on medical and family history

5.  Screen for cognitive impairments 

• Observe the patient and consider information provided by the patient, family, friends, caregivers, etc.
• Consider using a cognitive test, health disparities, chronic conditions, and other factors that contribute to cognitive impairment risk

6. Update the patient’s screening schedule

7. Update the patient’s risk factors and conditions and recommended or current primary, secondary, or tertiary interventions. Include:

• Mental health conditions such as depression, and cognitive impairment substance use disorder(s)
• Risk factors or conditions identified during the patient’s IPPE
• Treatment options and the related risks and benefits

8. Give the patient personalized advice and referrals to health education or preventive health counseling services or programs for lifestyle interventions to reduce health risks and promote self-management and wellness if needed, such as for:

• Fall prevention
• Nutrition
• Physical activity
• Tobacco-use cessation
• Weight loss
• Cognition

9. Provide advance care planning (ACP) services if the patient wants

10. Review the patient’s current opioid prescriptions and assess for opioid use disorder (OUD) risk factors. Suggest non-opioid treatment options and refer the patient to a specialist if needed. 

11. Screen for potential substance use disorders (SUDs)

12. Assess the patient for Social Determinants of Health (SDOH) (optional)

Coding and Billing for the AWV

Accurate coding, diagnosis, and billing are important when submitting a claim for an AWV. Here’s a breakdown of what to know.

AWV Coding

Use one of the following HCPCS codes to file AWV claims.

G0438 — covers an initial annual wellness visit that includes a personalized prevention plan of service (PPS)

G0439 — covers a repeat annual wellness visit, includes a PPS

G0468 — covers a federally qualified health center (FQHC) visit that for an IPPE or AWV and the typical bundle of Medicare-covered services provided per diem to a patient receiving an IPPE or AWV. (Learn more in the Medicare Claims Processing Manual, Chapter 9, section 60.2.)

When Advanced Care Planning Is Done as Part of the AWV

99497 —  covers advance care planning including the explanation and discussion of advance directives, such as standard forms. Covers the first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.

99498  — covers explaining and discussing ACP and completing (when applicable) advance directives, such as standard forms. Covers each additional 30 minutes beyond 99497. List this code separately in addition to code for primary procedure.

If an SDOH Risk Assessment Is Done as Part of the AWV

G0136 — Covers administering a standardized, evidence-based 5 to 15 minutes SDOH risk assessment.

AWV Diagnosis Codes

Include at least one diagnosis code when you submit a claim for an AWV. Know that Medicare doesn’t require that you document an AWV diagnosis code. So, you can use any diagnosis code that’s consistent with the patient’s exam.

If you do an ACP or SDOH risk assessment, include codes for those as well. 

Billing for an AWV

AWVs are covered by Medicare Part B covers an AWV if performed by a:

• Physician (MD or DO)
• Qualified NPP (CCNS, NP, or PA)
• Other medical professional, such as a health educator, registered dietitian, nutrition professional, or other licensed practitioner, or a team of medical professionals supervised by a physician

If you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M)service, Medicare may pay for the additional service. To help ensure payment, report the additional CPT code with modifier –25. 

Note: CMS and Medicare resources emphasize that preventive coverage rules can differ when additional services are billed or when frequency limits apply. For teams building AWV workflows, use Medicare preventive coverage guidance and CMS billing instructions as your foundation of information.

The added portion of the visit must be deemed 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 for G0438 or G0439 once in a 12-month period per patient. 

Important: Don’t  bill G0438 or G0439 within 12 months of a s G0402 (IPPE) claim for the same patient. If you do, Medicare will deny the claim and say “Benefit maximum for this time period or occurrence has been reached.”

Coding and Billing for Advance Care Planning (ACP) as Part of an Annual Wellness Visit 

Medicare waives the patient’s coinsurance and Medicare Part B deductible for an  ACP one a year when it’s:

• Provided the same day and by the same provider as the AWV
• Billed with modifier 33 (preventive services) on the same claim as the AWV 

The patient will be charged a deductible and coinsurance when the ACP is done outside of the AWV. You can report ACP any number of times for a patient. For multiple claims, simply document the patient’s change of health status and/or wishes.

Coding and Billing for an SDOH Risk Assessment as Part of an AWV 

Medicare waives the patient’s coinsurance and Medicare Part B deductible for an SDOH risk assessment once every six months when it’s:

• Provided the same day and by the same provider as the AWV
• Billed with modifier 33 (preventive services) on the same claim as the AWV 

Find Patients Eligible for Medicare Annual Wellness Visits

Identifying patients eligible for preventive care, including an AWV, can improve outcomes and reduce downstream costs.

Settings in modern EHRs can help identify eligible patients by checking:

• Medicare Part B enrollment effective date
• Patient medical/social history flags and chronic condition risks
• Preventive services due based on age/risk factors

Care Management Services as Part of the AWV

Care management services are an important part of the AWV. The visit is designed to focus not on physical health, but on prevention, so providers can offer personalized health advice and preventive services to every Medicare beneficiary they serve.

The AWV gives providers the chance to create a practical care roadmap that the care team can use for year-round follow-up, including for screenings, referrals, patient outreach, and chronic-risk monitoring.

AWVs and the Azalea Ambulatory EHR

When you choose the Azalea Ambulatory EHR, you can quickly and easily customize chart notes using chart note templates. And with a chart note template, you can easily create a template for initial and subsequent visits to use as your own Medicare Annual Wellness Visit Checklist.

Medicare Annual Wellness Visit FAQs