Annual Wellness Visit
A yearly, conversation-based preventive visit to build or update a personalized prevention plan, distinct from a routine physical exam, plus an optional same-day advance care planning discussion.
What it is
The Annual Wellness Visit (AWV) is a yearly Medicare Part B preventive benefit focused on prevention planning: a health risk assessment, review of history and medications, a cognitive impairment screening, and a personalized, written schedule of recommended screenings and preventive services.
It is not a routine physical exam and includes no hands-on diagnostic workup for a new complaint. CMS does allow a significant, separately identifiable, medically necessary E/M visit (99202-99205 or 99211-99215, appended with modifier 25) to be billed on the same day as the AWV, so a new complaint doesn't necessarily require scheduling a second visit. Advance Care Planning (99497/99498) is a related, optional, separately reportable service that is often furnished on the same day as the AWV.
Who qualifies
- Patient is enrolled in Medicare Part B
- Initial AWV (G0438): patient has not had an AWV before, and it has been at least 12 months since Part B enrollment or since the one-time 'Welcome to Medicare' Initial Preventive Physical Examination (IPPE), if one was done (an IPPE is not required to qualify)
- Subsequent AWV (G0439): at least 12 months have passed since the patient's initial AWV or most recent subsequent AWV
Codes at a glance
| Code | What it covers | Threshold | Approx. payment | Details link |
|---|---|---|---|---|
| G0438 | Initial Annual Wellness Visit, including personalized prevention plan | Once, at least 12 months after Part B enrollment or the IPPE | ~$174 | Details → |
| G0439 | Subsequent Annual Wellness Visit, including personalized prevention plan | Once every 12 months after the initial AWV | ~$138 | Details → |
| 99497 | Advance Care Planning, first 30 minutes, face-to-face | Reportable at 16-30 minutes face-to-face with patient, family, or surrogate | ~$87 | Details → |
| 99498 | Advance Care Planning add-on, each additional 30 minutes | Each additional 30 minutes | ~$78 | Details → |
Approximate CY2026 Medicare Physician Fee Schedule national non-facility payment benchmark for non-QP clinicians, before geographic, sequestration, and claim-specific adjustments. Actual reimbursement varies by locality, practitioner status, payer, and billing circumstances. Verify the applicable amount with CMS or your Medicare Administrative Contractor.
What's required to bill
- A Health Risk Assessment completed by or with the patient
- Review of the patient's medical and family history, current providers, and current medications and supplements
- Routine measurements (height, weight, blood pressure, body mass index)
- Detection of any cognitive impairment, through direct observation and/or a validated screening tool
- A written, personalized prevention plan listing recommended screenings and preventive services for the next 5 to 10 years
- Advance care planning discussion offered (optional for the patient to accept)
- For subsequent AWVs: an updated Health Risk Assessment and an update to the prevention plan reflecting any changes
Documentation checklist
- Completed Health Risk Assessment
- Updated medical/family/social history and current medication list
- Cognitive impairment screening results
- Written prevention plan / screening schedule given to the patient
- Date of the patient's prior AWV or IPPE, to confirm the 12-month spacing requirement
- If Advance Care Planning was furnished same-day: time spent and a summary of the discussion, tied to 99497/99498
Common billing mistakes
- Billing the initial AWV (G0438) within 12 months of Part B enrollment or the IPPE
- Billing an AWV (G0438 or G0439) more often than once every 12 months
- Treating the AWV as a substitute for a routine physical exam and skipping the required prevention-planning elements (HRA, cognitive screening, written plan)
- Not documenting the separate advance care planning discussion time when 99497/99498 are billed alongside the AWV
- Not documenting a significant, separately identifiable E/M visit (modifier 25) when a new complaint is actually addressed during the AWV encounter, whether on the same day or at a separate visit
FAQ
Is the Annual Wellness Visit the same as a routine physical exam?
No. The AWV is a conversation-based prevention-planning visit built around a health risk assessment and a written screening schedule. It doesn't include a hands-on physical exam for new complaints, those should be addressed in a separate visit.
When can a patient get their first AWV?
The initial AWV (G0438) can't take place within 12 months of the patient's Part B enrollment or their one-time 'Welcome to Medicare' preventive visit (IPPE), if they had one. A prior IPPE isn't required to qualify for an AWV.
Can Advance Care Planning be billed on the same day as the AWV?
Yes, 99497 (and the add-on 99498) can be billed on the same day as an AWV, and is reportable once at least 16 minutes of the face-to-face discussion have occurred. The Part B deductible and coinsurance are waived, once per calendar year, only when it's furnished by the same practitioner as the AWV, billed on the same claim as the AWV, and reported with modifier 33. If billed as a standalone service on a different day, or without modifier 33, standard Part B cost-sharing applies.