medicare annual wellness visit health risk assessment

Medicare Wellness Visits Back to MLN Print November 2023 Updates

What’s Changed?

• Added information about monthly chronic pain management and treatment services
• Added information about checking for cognitive impairment during annual wellness visits
• Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

• Health Equity Technical Assistance Program
• Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

• Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
• Current medications, supplements, and other substances the person may be using
• Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
• Physical activities
• Social activities and engagement
• Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

• Current or past experiences with depression
• Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

• Ability to perform activities of daily living (ADLs)
• Hearing impairment
• Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
• Visual acuity screen
• Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

• Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
• If you agree to follow their advance directive
• This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

• Review any potential opioid use disorder (OUD) risk factors
• Evaluate their pain severity and current treatment plan
• Provide information about non-opiod treatment options
• Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

• A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
• Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

• Physician (doctor of medicine or osteopathy)
• Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

• 42 CFR 410.16
• Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
• Section 80 of the Medicare Claims Processing Manual, Chapter 18
• U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

• You or the patient can update the HRA before or during the AWV
• Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
• Demographic data
• Health status self-assessment
• Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
• Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
• Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

• Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
• Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

• Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
• Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

• Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

• Checklist for the next 5–10 years
• United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
• Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

• A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
• Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
• IPPE risk factors or identified conditions
• Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

• Fall prevention
• Physical activity
• Tobacco-use cessation
• Social engagement
• Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

• Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
• Future care decisions they might need or want to make
• How they can let others know about their care preferences
• Caregiver identification
• Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

• Review any potential OUD risk factors
• Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

• Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

• Mental health conditions, including depression, substance use disorders , and cognitive impairments
• Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

• Medical records, including immunization records
• Detailed family health history
• Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
• Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

• Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be 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 G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

• Provided on the same day as the covered AWV
• Provided by the same provider as the covered AWV
• Billed with modifier 33 (Preventive Service)
• Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

• 42 CFR 410.15
• Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

• We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
• We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

• We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
• We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
• We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

• We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
• Patients pay 100% out of pocket

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The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Yearly "Wellness" visits

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible  doesn’t apply. 

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning .

Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed. 

Related resources

• Preventive visits
• Social determinants of health risk assessment

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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .

Eligibility

Medicare Part B covers the Annual Wellness Visit if:

• You have had Part B for over 12 months
• And, you have not received an AWV in the past 12 months

Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.

Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
• This includes screening for hearing impairments and your risk of falling.
• Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
• Learn about your medical and family history
• Medications include prescription medications, as well as vitamins and supplements you may take
• Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
• Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
• Screen for depression
• Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.

AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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Doctor Visits

Get Your Medicare Wellness Visit Every Year

Take Action

If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.

What happens during a yearly wellness visit?

First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.

During your visit, the doctor or nurse will:

• Go over your health risk assessment with you
• Measure your height and weight and check your blood pressure
• Ask about your health history and conditions that run in your family 
• Ask about other doctors you see and any medicines you take
• Give advice to help you prevent disease, improve your health, and stay well
• Look for any changes in your ability to think, learn, or remember
• Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed

If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist. 

Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick. 

Learn more about yearly wellness visits .

Plan Your Visit

When can i go for a yearly wellness visit.

You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.

Do I need to have a “Welcome to Medicare” visit first?

You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.

If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit. 

Learn more about the “Welcome to Medicare” visit .

What about cost?

With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.

If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.

Who Can Get Medicare?

Medicare is a federal health insurance program. You may be able to get Medicare if you:

• Are age 65 or older
• Are under age 65 and have a disability
• Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
• Have permanent kidney failure (called end-stage renal disease)

You must be living in the United States legally for at least 5 years to qualify for Medicare.  Answer these questions to find out when you can sign up for Medicare .

Make an Appointment

Take these steps to help you get the most out of your Medicare yearly wellness visit.

Schedule your Medicare yearly wellness visit.

Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.

If you're looking for a new doctor,  check out these tips on choosing a doctor you can trust .  

To find a doctor who accepts Medicare:

• Search for a doctor on the Medicare website
• Call 1-800-MEDICARE (1-800-633-4227)
• If you use a TTY, call Medicare at 1-877-486-2048

Gather important information.

Take any medical records or information you have to the appointment. Make sure you have important information like:

• The name and phone number of a friend or relative to call if there’s an emergency
• Dates and results of checkups and screening tests
• A list of vaccines (shots) you’ve gotten and the dates you got them
• Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
• Phone numbers and addresses of other places you go to for health care, including your pharmacy

Make a list of any important changes in your life or health.

Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:

• Losing your job
• A death in the family
• A serious illness or injury
• A change in your living situation

Know your family health history.

Your family's health history is an important part of your personal health record.  Use this family health history tool  to keep track of conditions that run in your family. Take this information to your yearly wellness visit.

Ask Questions

Make a list of questions you want to ask the doctor..

This visit is a great time to ask the doctor or nurse any questions about:

• A health condition
• Changes in sleeping or eating habits
• Pain or discomfort
• Prescription medicines, over-the-counter medicines, or supplements

Some important questions include:

• Do I need to get any vaccines to protect my health?
• How can I get more physical activity?
• Am I at a healthy weight?
• Do I need to make any changes to my eating habits?

Use this question builder tool  to make a list of things to ask your doctor or nurse.

It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.

What to Expect

Know what to expect at your visit..

The doctor or nurse will ask you questions about your health and safety, like:

• Do you have stairs in your home?
• What do you do to stay active?
• Have you lost interest in doing things you usually enjoy?
• Do you have a hard time hearing people on the phone?
• What medicines, vitamins, or supplements do you take regularly?

The doctor or nurse will also do things like:

• Measure your height and weight
• Check your blood pressure
• Ask about your medical and family history

Make a wellness plan with your doctor.

During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.

Your plan may include:

• Getting important screenings for cancer or other diseases
• Making healthy changes, like getting more physical activity

Follow up after your visit.

During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.

If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.

Add any new health information to your personal health documents.

Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.

Medicare offers an online tool called  MyMedicare  to help you track your personal health information and Medicare claims. If you have your Medicare number, you can  sign up for your MyMedicare account now .

Healthy Habits

Take care of yourself all year long..

After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:

• Getting important screenings
• Getting vaccines for older adults
• Keeping your heart healthy
• Preventing type 2 diabetes
• Lowering your risk of falling

Your plan could also include:

• Getting active
• Eating healthy
• Quitting smoking
• Watching your weight

Content last updated February 9, 2023

Reviewer Information

This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services

Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group

November 2022

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Staying healthy as you age: Medicare Annual Wellness Visits explained

• Family Medicine

Getting older has many advantages. You have the wisdom that comes with experience, plenty of stories to share and are usually more comfortable with who you are. If you have Medicare Part B coverage, another benefit is that you qualify for an Annual Wellness Visit.

This visit aims to keep you healthy and give you the tools to have a good quality of life as you age. The Medicare Annual Wellness Visit allows your health care team to review your health status, design a personalized prevention plan and connect you with critical preventive services covered by Medicare Part B.

Medicare Annual Wellness Visits create a snapshot of your health and provide a reference point for future visits. This improves the chances that a potentially serious health issue is caught early.

It's important to understand that Medicare Annual Wellness Visits differ from a physical exam conducted by your primary care provider.

Here are three major differences between these types of appointments:

1. provider seen.

A nurse or nurse practitioner typically conducts a Medicare Annual Wellness Visit. In most cases, you will not see your primary doctor or health care provider during this appointment.

A physical exam is conducted by your primary care provider, who may be a doctor, nurse practitioner or physician assistant.

2. What's included

A Medicare Annual Wellness Visit is meant to enhance your health and focuses on your well-being through interviews and assessments of your lifestyle factors. You will also be asked to fill out a health risk assessment before your appointment.

During a Medicare Annual Wellness Visit, the nurse will:

• Evaluate your fall risk.
• Measure your height, weight and blood pressure.
• Offer referrals to other health education or preventive services.
• Provide information related to voluntary advance care planning.
• Screen for cognitive impairments like dementia.
• Screen for depression.
• Update your medical and family history.

A physical exam includes an age and gender-appropriate comprehensive head-to-toe checkup. This exam is completed to detect and prevent illnesses or injuries.

During a physical exam, your primary care provider may:

• Check your vital signs.
• Discuss acute or urgent health issues.
• Review chronic health conditions.
• Review your medications.
• Perform a physical exam.
• Ask about your activity level, relationships and home environment.

3. Frequency and cost

A Medicare Annual Wellness Visit can be scheduled after you have Medicare Part B coverage for at least 12 months and each year after that. Subsequent visits must be at least 365 days, or one full year, after your previous year's visit. Medicare offers the Annual Wellness Visit at no cost for those who have Medicare Part B coverage.

A physical exam can be scheduled at any time. You or your insurance carrier will be responsible for the cost of this exam. The total will vary based on what tests and services are completed during the visit. Ask your insurance carrier for coverage details.

Medicare Annual Wellness Visits and physical exams are best scheduled for the same day, with the wellness visit occurring first. Contact your health care team and ask if you qualify for a Medicare Annual Wellness Visit.

Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.

Related Posts

Here’s one way to satisfy Medicare’s recent addition to the annual wellness visit requirements.

CINDY HUGHES, CPC

Fam Pract Manag. 2012;19(2):11-12

Cindy Hughes is a coding and compliance consultant with Medical Revenue Solutions, Oak Grove, Mo., and a contributing editor to Family Practice Management. Until recently, she was a member of the staff of the American Academy of Family Physicians. Author disclosure: no relevant financial affiliations disclosed.

Family Practice Management ( FPM ) published several articles and an encounter form last year related to Medicare’s new annual wellness visit (AWV) benefit. Some physicians decided not to offer the AWV due to the complexity of the requirements, but many adapted to Medicare’s version of preventive care and provided these visits in 2011. Unfortunately, the requirements for 2012 have changed.

MEDICARE WELLNESS CHECKUP: HEALTH RISK ASSESSMENT FORM

The Affordable Care Act directed the Centers for Medicare & Medicaid Services (CMS) to require that a health risk assessment (HRA) be completed as part of the Medicare AWV. Efforts by the American Academy of Family Physicians and others to persuade CMS to delay the HRA requirement and allow time for physicians and practices to prepare for this change were unsuccessful, and late last year CMS published the final rule making the HRA requirement effective Jan. 1, 2012. The purpose of the HRA, according to CMS, is to help systematize the identification of health behaviors and risk factors such as tobacco use and nutrition that the physician can discuss with the patient in an effort to reduce risk factors and related diseases. The idea is that physicians will use the information from the HRA in developing a personalized prevention plan for the patient.

CMS has not required a specific HRA form. The Centers for Disease Control and Prevention published a “framework” for the HRA in a 52-page report in December. The report provides a 6-page example of an HRA, but the example does not contain all of the 34 elements required by CMS in the final rule definition. 1 The HRA must be written at a sixth-grade literacy level and be designed so that most patients can complete it in 20 minutes or less. It does not have to be scored.

Compliant HRA tools are presumably being developed by a variety of organizations. One source, HowsYourHealth.org, provides free online assessments that meet the CMS requirements and has developed the paper-based questionnaire published with this article (see HowsYourHealth.org and the Medicare health risk assessment ).

HOWSYOURHEALTH.ORG AND THE MEDICARE HEALTH RISK ASSESSMENT

While a number of health risk assessments for the Medicare annual wellness visit (AWV) may be in development, Family Practice Management is aware of only one source so far. HowsYourHealth.org , a not-for-profit service of the Dartmouth Co-Op Project , offers two interactive questionnaires that meet the requirements for the AWV:

A brief questionnaire simply asks the required questions and summarizes the results for the practice as a personalized action plan for the patient. It takes less than 10 minutes to complete. Practices may refer their Medicare patients to the site and ask them to print out the summary action plan before their wellness visit or ask them to complete it on paper. A PDF of this version is available for download.

A longer questionnaire, available at http://www.medicarehealthassess.org and at http://www.howsyourhealth.org , offers a more comprehensive health checkup. This survey adds to the required items of the AWV a full assessment of the patient’s problems and priorities (“what is the matter” and “what matters”). It requires more time to complete, but it offers more information to patients and practices. It is available for patients of all ages.

A sample of patient and clinician output from the short-form questionnaire is available at http://www.medicarehealthassess.org/checklist , as is information on the use of short-form, patient-reported information to improve care. A sample of output from the comprehensive questionnaire is available at http://www.howsyourhealth.org/medicare .

There is no charge for use of either questionnaire, although practices that wish to take advantage of available enhancements to the longer-form questionnaire are asked to pay a fee to help support the HowsYourHealth.org website. According to John Wasson, MD, who supervises both HowsYourHealth.org and http://www.medicarehealthassess.org , a practice can customize the assessment, receive real-time aggregate information about its patients’ needs and experiences of care, and use a patient-loaded registry. Practices who choose to customize HowsYourHealth.org for patients of all ages may test the tool on as many as 50 patients without charge. If satisfied with the results of testing, practices are asked to pay a fee of $350 per year for up to 10 clinicians to support the maintenance and further development of the tools.

So what does this mean to physicians who provide AWVs? Before the face-to-face encounter, your patient needs to complete an HRA. Some patients may need encouragement and assistance from your staff. To compensate for this added staff time, CMS increased the relative value units of the AWV to 4.89 for the initial AWV and 3.26 for subsequent AWVs, thus increasing average reimbursements by an underwhelming $5.39 for the initial AWV and $3.59 for subsequent AWVs.

Other than adding the HRA component, CMS did not change the content of the AWV. Some questions that are required in the HRA are already required elements of the AWV.

Some patients may object to being asked to fill out yet another form; in such cases, your best bet is to document the patient’s reasons for not completing the questionnaire and get as much from the visit as you can, keeping in mind that CMS’ overarching goal is that Medicare beneficiaries receive a personalized prevention plan. Once a patient has completed the HRA, you need only review and update the answers in subsequent AWVs. After adding an HRA to your process, you can continue to use the FPM encounter form and related articles as references for the rest of the AWV (see “ FPM resources for the Medicare annual wellness visit ”).

FPM RESOURCES FOR THE MEDICARE ANNUAL WELLNESS VISIT

“ What You Need to Know About the Medicare Preventive Services Expansion .” Hughes C. January/February 2011:22-25. This article features an annual wellness visit encounter form ).

“ Answers to Your Questions About Medicare Annual Wellness Visits .” Hughes C. March/April 2011:13-15.

“ Medicare Annual Wellness Visits Made Easier .” Hughes C. July/August 2011:10-14.

Medicare Program. Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012. Fed Regist . 2011;76(228):73306. Accessed Feb. 14, 2012. http://www.gpo.gov/fdsys/pkg/FR-2011-11-28/pdf/2011-28597.pdf

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Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

A Framework for Patient-Centered Health Risk Assessments

The Affordable Care Act (ACA), Section 4103 , requires that a health risk assessment be included in the annual wellness visit benefit authorized for Medicare beneficiaries under the Act. CDC has collaborated with the Centers for Medicare and Medicaid Services (CMS) to develop an evidence-informed framework document for this type of assessment, A Framework for Patient-Centered Health Risk Assessments: Providing Health Promotion and Disease Prevention Services to Medicare Beneficiaries [PDF, 3 MB] .

This framework includes sections on Use of HRAs and Follow-Up Interventions that evidence suggests can influence health behaviors; Defining the HRA Framework (i.e., HRA Plus process ) and rationale for its use; History of Health Risk Assessments, and a Suggested Set of HRA Questions.

Background on Developing this Document

In addition to reviewing the most recent literature, CDC convened internal and external workgroups to provide input into the development process for this framework.

A public request for information published in the Federal Register on November 16, 2010, was open for comment until January 3, 2011. All of those comments are available in this document, Final Comments on HRAs [PDF, 3.5MB] .

CDC convened a public forum in Atlanta at CDC headquarters on February 1–2, 2011. A compilation of the public forum proceedings provides additional input into the guidance.

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• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
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What Is the Medicare Annual Wellness Visit?

• How the Medical Wellness Visit Works
• Types of AWVs

Routine Physical Exam vs. AWV

• Requirements
• Frequently Asked Questions (FAQs)

The Bottom Line

• Health Insurance
• Definitions A - M

Medicare Annual Wellness Visit: What Is It?

Luis Alvarez / Getty Images

The Medicare annual wellness visit is a free preventive benefit available to Medicare beneficiaries every 12 months. Both Original Medicare and Medicare Advantage offer this visit with your doctor to review your mental and physical health and cognitive abilities. Together, you create a personalized plan to address concerns based on your current health and any risk factors. 

Key Takeaways

• The Medicare annual wellness visit is a check-in every 12 months with your healthcare provider.
• Your provider assesses your current and recent physical and mental state and looks for potential risk factors. 
• The annual wellness visit isn’t an appointment to address new health concerns or symptoms. Bringing these up could lead to additional charges from your doctor’s office.
• Both Original Medicare and Medicare Advantage plans offer Medicare annual wellness visits.

How the Medical Wellness Visit Works 

The annual wellness visit includes a health risk assessment, a review of your medical and family health history, a collection of your current healthcare providers and suppliers, and a self-assessment of your health status.

In advance, the doctor will likely give you a questionnaire. It takes about five minutes to fill out.

The Medicare annual wellness visit attempts to uncover any changes impacting your ability to care for yourself (such as dressing, shopping, and financial management ) and increased health risks from behavioral factors (smoking, physical activity, seat belt use) and emotional factors (depression, anger, loneliness).

The doctor will measure and document: 

• Demographic information
• Body mass index (BMI) or waist circumference
• Blood pressure
• Other measurements based on medical and family history
• Any cognitive impairments
• Potential depression risk factors
• Ability to perform daily activities
• Risk of a fall 
• Any hearing impairment
• Potential substance use disorders and opioid prescriptions
• Other safety concerns

Using this information, the doctor helps maintain a screening schedule based on your risk factors and conditions. You’ll get personalized advice and referrals to health services and programs to help address physical safety and mental health issues and control risk factors such as smoking.  

Your wellness visit can also include advance care planning, also known as advance directive planning. This is a face-to-face conversation between you and your healthcare professional about your healthcare wishes and medical treatment preferences should you become unable to communicate or make decisions about your care. 

You won’t pay anything for your visit (including the Part B deductible) if your doctor accepts the Medicare assignment. 

But to have the visit remain free, you’ll also need to stay within the Medicare annual wellness visit’s boundaries of discussion topics. Don’t talk about your new knee ache; make a separate appointment for that. 

If your doctor orders additional tests or services outside the scope of a Medical wellness visit, you will have to pay the coinsurance and Part B deductible for those tests. 

Types of Medicare Annual Wellness Visits

There are two types of Medicare annual wellness visits (AWVs)—the initial AWV and follow-up AWVs that happen in subsequent years. 

Your first Medicare annual wellness visit will be more thorough than later ones. It will include establishing a baseline regarding your physical and mental health history, risk factors, and any signs of cognitive impairment. You'll also set up a personalized screening schedule going forward. The doctor will discuss your advance care planning if you wish. 

After the first visit, the wellness visits review and update changes to the above, including:

• Health risk assessment
• Medical and family history 
• Current providers and suppliers
• Weight and blood pressure measurements
• Cognitive impairment assessment
• Written screening schedule 
• Risk factors and interventions 
• Referrals to services and programs
• Advance care planning
• Opioid prescriptions 

Your annual wellness exam reviews your personalized prevention plan of services and is focused on managing health risks. Medicare covers an annual AWV 12 months after the last AWV (date of service), paying all costs as long as the doctor accepts Medicare. The AWV can also incorporate advance care planning discussions.

In comparison, a routine physical is a medical exam performed without addressing treatment or diagnosis for a specific illness, symptom, complaint, or injury. 

Original Medicare does not cover routine physical exams; patients must pay all costs out of pocket. However, some Medicare Advantage plans cover annual physicals.

Physical exams don’t typically include discussions of advance care planning. However, the AWV and other Medicare benefits cover some aspects of the routine physical, so you may see some overlap.

Requirements for the Medicare Annual Wellness Visit

For Medicare to cover your Medicare annual wellness visit, it must be performed by a physician (doctor of medicine or osteopathic medicine) or a nurse practitioner, physician assistant, or clinical nurse specialist. 

You must have been enrolled in Medicare Part B for more than 12 months. In other words, your first yearly wellness visit can’t occur within 12 months of your Part B enrollment. 

Your Medicare annual wellness visit also can’t take place within 12 months of your “Welcome to Medicare” preventive visit, which happens when you first join Medicare. That visit reviews your health-related medical and social history and provides education on preventive services. The “Welcome to Medicare” visit is called the Initial Preventive Physical Exam or IPPE.

However, to qualify for your annual wellness visit, you don’t need to have completed the “Welcome to Medicare” preventive visit.

To prepare for your Medicare annual wellness visit, you’ll need to bring: 

• Medical records
• Immunization records
• Family health history
• A list of all medications, supplements, and vitamins, and information on how often and how much of each you take
• A list of your current healthcare providers and suppliers, including mental health specialists

Frequently Asked Questions (FAQs) 

What’s the difference between a medicare wellness visit and an annual physical.

A wellness visit isn’t designed to incorporate a full panel of lab tests and in-office exams. It’s more of a quick check-in with your doctor using Medicare’s standardized list of questions concerning your overall mental and physical health and your ability to care for yourself. 

Does the Medicare Wellness Exam Include Blood Work?

No, the Medicare Annual Wellness Exam’s coverage doesn’t include clinical lab tests. Your doctor could make a referral for blood tests or lab tests as part of the AWV. Medicare Part B typically covers medically necessary lab work, such as blood tests.

Does Medicare Cover an Annual Physical?

Some Medicare Advantage plans cover an annual physical, but Original Medicare does not. However, Original Medicare Part B does cover dozens of preventive tests, screenings, and services that are usually part of a routine preventive physical, including screening for: 

• Colorectal cancer, prostate cancer, and breast cancer 
• Abdominal aortic aneurysms (via ultrasound)
• Cardiovascular disease 

The Medicare annual wellness visit allows you to discuss your overall health, quality of life, mental health, mood, and ability to think with your doctor. Your care provider can watch for changes and order more tests or help with necessary interventions. Catching problems early can keep you healthier and help you avoid expensive treatments later on. 

Centers for Medicare and Medicaid Services. “ Medicare Wellness Visits .”

Medicare.gov. “ Yearly ‘Wellness’ Visits .”

Medicare.gov. “ Preventative and Screening Services .”

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The Annual Wellness Visit Health Risk Assessment: Potential of Patient Portal-Based Completion and Patient-Oriented Education and Support

Affiliations.

• 1 Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA.
• 2 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
• 3 Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• 4 School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
• 5 Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
• 6 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
• PMID: 38618518
• PMCID: PMC11010311
• DOI: 10.1093/geroni/igae023

Background and objectives: Patient portals are secure online platforms that allow patients to perform electronic health management tasks and engage in bidirectional information exchange with their care team. Some health systems administer Medicare Annual Wellness Visit (AWV) health risk assessments through the patient portal. Scalable opportunities from portal-based administration of risk assessments are not well understood. Our objective is 2-fold-to understand who receives vs misses an AWV and health risk assessment and explore who might be missed with portal-based administration.

Research design and methods: This is an observational study of electronic medical record and patient portal data (10/03/2021-10/02/2022) for 12 756 primary care patients 66+ years from a large academic health system.

Results: Two-thirds ( n = 8420) of older primary care patients incurred an AWV; 81.0% of whom were active portal users. Older adults who were active portal users were more likely to incur AWV than those who were not, though portal use was high in both groups (81.0% with AWV vs 76.8% without; p < .001). Frequently affirmative health risk assessment categories included falls/balance concerns (44.2%), lack of a documented advanced directive (42.3%), sedentary behaviors (39.9%), and incontinence (35.1%). Mean number of portal messages over the 12-month observation period varied from 7.2 among older adults affirmative responses to concerns about safety at home to 13.8 for older adults who reported difficulty completing activities of daily living. Portal messaging varied more than 2-fold across affirmative health risk categories and were marginally higher with greater number affirmative (mean = 13.8 messages/year no risks; 19.6 messages/year 10+ risks).

Discussion and implications: Most older adults were active portal users-a group more likely to have incurred a billed AWV. Efforts to integrate AWV risk assessments in the patient portal may streamline administration and scalability for dissemination of tailored electronically mediated preventive care but must attend to equity issues.

Keywords: Consumer health information technology; Health services; Medicare; Preventive care.

© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.