Overview of Annual Wellness Visits
What is a Medicare Annual Wellness Visit?
An Annual Wellness Visit (AWV) is a preventive health assessment for Medicare beneficiaries
that focuses on creating personalized prevention plans, assessing health risks, and updating screenings to proactively manage overall health.
1. Personalized Care
The AWV is a powerful opportunity to personalize preventive care for each patient. Rather than taking a one-size-fits-all approach, the AWV enables providers to assess individual risk factors—such as family history, current medications, cognitive function, and lifestyle habits—and tailor wellness plans accordingly.
2. Identify Risk Factors Early
By identifying risk factors before they become acute or costly, providers can tailor care plans early and refer the patient to any necessary specialists.
3. A Vital Component of Valued-Based Care
Value-Based Care (VBC) models focus on outcomes rather than volume. The AWV is a key tool within this framework that helps providers meet quality metrics and demonstrate improved patient outcomes. AWVs serve as a foundation for closing care gaps and enhancing care continuity, both of which are core pillars of VBC.
4. Maximize Practice Revenue
AWVs serve as a strategic revenue opportunity for practices. Medicare reimburses providers for each AWV conducted, and when combined with other allowable screenings or services (such as advance care planning or behavioral health assessments), these visits can generate significant income. Furthermore, AWVs often identify additional care needs that lead to follow-up visits, specialist referrals, or diagnostic tests that are also reimbursable. All of this supports a financially sustainable care model that aligns with better patient outcomes.
5. Reduce Healthcare Costs
By shifting the focus from a reactive to a preventive care model, AWVs help reduce overall healthcare spending. Detecting health risks early and engaging patients in wellness plans can prevent costly interventions down the line. Additionally, patients who regularly attend AWVs are more likely to adhere to medication regimens, attend follow-up appointments, and engage in lifestyle changes, all of which contribute to improved health and fewer acute episodes requiring expensive hospital stays.
6. Operational Efficiency and Long-Term Impact
Integrating AWVs into practice operations not only enhances patient care but also boosts clinical workflow efficiency. Practices that use digital tools or AWV platforms (like Clinii) can streamline assessments, documentation, and coding compliance—saving administrative time while increasing output. Consistent delivery of AWVs improves patient engagement, strengthens the provider-patient relationship, and contributes to the long-term success of both the practice and the broader healthcare system.
Codes
Annual Wellness Visit Pathway
HCPCS G0438
Includes a review of medical and family history, risk assessment, and creation of a personalized prevention plan.
HCPCS G0439
Update of Health Risk Assessment (HRA) and reassess personalized prevention plan.
Advance Care Planning Pathway
CPT 99497
Discussion of patient's goals for care and treatment preferences, including advance directives, with the patient, family, and surrogate.
CPT 99498
Additional time for detailed care planning and discussion, usually following the initial session.
Frequently Asked Questions About Annual Wellness Visits
Who is Eligible for an AWV?
Clinii covers an AWV for all patients who have had Medicare coverage for longer than 12 months after their first Part
B eligibility date and who didn’t have an Initial Preventive Physical Exam (IPPE) or AWV within those past 12 months. We cover only one IPPE per patient per lifetime and one additional AWV every 12 months after the date of the patient’s last AWV (or IPPE).
Is an AWV the Same as an Annual Physical?
No. There are some important distinctions to note between AWVs and annual physicals. The latter typically serves the purpose of treating any current or pre-existing health conditions, running diagnostic tests, and performing a physical examination. AWVs do not involve a detailed physical examination and instead focus solely on preventive care and wellness planning.
Who Can Perform an AWV?
Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and medical professionals working under a physician’s direct supervision can perform AWVs.