Annual Wellness Visit

Published 09/08/2022

No, the Annual Wellness Visit (AWV) is a stand-alone billable service separate from the Initial Preventive Physical Exam (IPPE). The two services can never be performed at the same time. The IPPE can only be performed within the first 12 months of a beneficiary's first Medicare Part B entitlement period. The initial AWV cannot be performed within the first 12 months of a beneficiary’s first Medicare Part B entitlement period, or within 12 months of an IPPE.

Resource: CMS MLN Medicare Wellness Visits Educational Tool.

Last Reviewed: 9/8/2022

The HCPCS codes for the first Annual Wellness Visit (AWV) service (HCPCS code G0438) and subsequent AWV services (HCPCS code G0439) do not include other preventive services that are paid separately by Medicare. Such services can be provided on the same day as the AWV, but they should be identified separately using the appropriate HCPCS/CPT® codes. When practitioners perform preventive services in addition to an AWV visit, billing and payment edits will continue to apply for the additional services.

If the need arises to perform a significant, separately identifiable, medically necessary evaluation and management (E/M) service in addition to the AWV, CPT® codes 99201–99215 may be reported with CPT® modifier 25, depending on the clinical appropriateness of the circumstances. Some of the components of a medically necessary E/M service (e.g., a portion of history or physical examination) may have been part of the AWV and should not be included when determining the most appropriate E/M level of service to bill. These services must be medically necessary to treat an illness or injury or to improve the functioning of a malformed body member.

Please see the information in the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12 (PDF), Sections 30.6.1.1 and 30.6.2 to determine specific billing instructions.

Resource: CMS MLN Medicare Wellness Visits Educational Tool.

Last Reviewed: 9/8/2022

No, this visit is a preventive wellness visit and not a "routine physical checkup" that some seniors may receive every year or two from their physician or other qualified nonphysician practitioner. Medicare does not provide coverage for routine physical exams.

Resource: CMS MLN Medicare Wellness Visits Educational Tool.

Last Reviewed: 9/8/2022

No, coverage for the Annual Wellness Visit (AWV) is provided as a Medicare Part B benefit and both the coinsurance or copayment and the Medicare Part B deductible are waived for the AWV. However, if additional services are furnished in the same visit, cost sharing and deductible requirements may apply to the additional service.

ResourceCMS MLN Medicare Wellness Visits Educational Tool.

Last Reviewed: 9/8/2022

The first Annual Wellness Visit (AWV) service must be identified with HCPCS code G0438 and subsequent AWV services with HCPCS code G0439.

Resource: CMS MLN Medicare Wellness Visits Educational Tool.

Last Reviewed: 9/8/2022

Medicare Part B covers an AWV if performed by a:

  • Physician (a doctor of medicine or osteopathy)
  • Qualified nonphysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist) or
  • Medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals who are working under the direct supervision of a physician (doctor of medicine or osteopathy)

Resources

Last Reviewed: 9/8/2022