Medicare Annual Wellness Visits

Published April 2025

To ensure compliance and provide the best care for your patients, it's important to understand the key components and requirements of the Medicare Annual Wellness Visit (AWV).

Key Components:

• Health Risk Assessment (HRA)
• Routine Measurements
• Medical and Family History Review
• Medication Review
• Personalized Health Advice
• Screening Schedule
• Cognitive Assessment
• Social Care Needs Assessment
• Advance Care Planning

Billing Codes and Timeframes:

1. Initial Preventive Physical Examination (IPPE): HCPCS code G0402
   Members must complete this visit within the first 12 months of enrolling in Medicare Part B. If a Member misses this eligibility period, the Member would start with the initial AWV.
2. Initial AWV: HCPCS code G0438
   Members can complete their initial AWV 12 months after an IPPE or following 11 months of Medicare Part B enrollment if they missed the IPPE eligibility window.
3. Subsequent AWVs: HCPCS code G0439
   Members can complete their subsequent AWV 11 months after the initial AWV and every 11 months thereafter.

Access the Medicare Annual Wellness Visit Provider Coding Reference Guide for more details.

Documentation Requirements:

• Ensure thorough documentation of all components, including the HRA, routine measurements, and personalized health advice
• Document any additional services provided during the visit, these may not be covered under the AWV benefit and could result in out-of-pocket costs for the Member

Communication:

• Explain the purpose and components of the AWV to your patients
• Inform Members that the AWV is not a physical exam, and that additional tests or services may incur costs

Why should Providers Perform Annual Wellness Visits?

Clinical Outcomes

MVP Medicare and Dual Special Needs Plan (D-SNP) Members who complete an Annual Wellness Visit have fewer emergency department visits and have better coordination of care with specialists.

Quality of Care

Medicare Annual Wellness Visits help to reduce adverse medication events, improve vaccination rates, and identify undiagnosed conditions.

Be Well Rewards Member Incentive

MVP Medicare Members who complete their Annual Wellness Visit by November 30, 2025, will earn a $100 reward card.

Learn more about the Medicare Annual Wellness Visit.