Annual Wellness Visit Rules and Requirements

Learn how to stay compliant and efficient in managing this valuable program

What is an AWV?

An AWV is essentially a detailed, question-based assessment of a patient’s current health and risk factors and is free for patients with Medicare Part B.

Once per year, patients meet with a clinician to discuss their health history, answer any questions they may have about their health, and identify at-risk areas. Follow-ups can be provided to help reduce health risk factors identified in AWVs.

The overarching goal of AWVs is to create a complete personal and family health history for patients and help prevent future health problems.

What Are The 3 Types of AWVs?

WELCOME TO MEDICARE VISIT / IPPE (G0402)

This visit is offered to patients within 12 months after enrolling in Medicare. They can only receive this benefit once. The reimbursement is around $168.

INITIAL ANNUAL WELLNESS VISIT (G0438)

This visit is offered to patients only once in their lifetime. They are eligible within 11 calendar months after their IPPE. The reimbursement is around $173.

SUBSEQUENT ANNUAL WELLNESS VISIT (G0439)

Patients are eligible for this benefit every year after their Initial Annual Wellness Visit. The reimbursement is around $117.

Who Can Administer AWVs?

Health care professionals who may administer and bill AWV include:

Physician
Physician Assistant
Nurse Practitioner
Clinical Nurse Specialist
Medical Professional (includes health educators, registered dieticians or nutrition professionals, or other licensed practitioners)
Non-physicians must be legally authorized and qualified to provide AWVs in the state in which the services are rendered

Welcome To Medicare Visit / IPPE

This is a ‘once in a lifetime’ benefit patients can choose to receive when they are new to Medicare. They must receive this visit within the first 12 months of their Medicare Part B enrollment.

If 12 months have passed and the patient has not used this benefit, they are no longer eligible to receive it. Instead, they would be eligible for an Initial Annual Wellness Visit.

During the visit, providers should cover the following with patients:

Check height, weight, blood pressure, body mass index (BMI), and vision
Review medical and social history
Review for mental health conditions
Review a patient’s ability to function safely in the home and community
Provide the patient with information, counseling, and referrals related to any identified risk factors and/or other health needs
Provide the patient with information about preventive services they may need

Initial Annual Wellness Visit

This is most similar to what you will have provided the patient in their IPPE. A patient is eligible for an Initial Annual Wellness Visit if 11 full calendar months have passed since their IPPE (Welcome to Medicare Visit).

If the patient didn’t use their IPPE within the first year after Medicare enrollment, they are likely eligible for their Initial Annual Wellness Visit.

Subsequent Annual Wellness Visit

The Subsequent Annual Wellness Visit is offered to Medicare patients every year but only after they have completed an Initial Annual Wellness Visit.

Patients are eligible for this visit 11 full calendar months after their Initial Annual Wellness Visit. You’ll go over the following with patients:

Check weight, blood pressure, and other routine measurements
Update the patient’s HRA, family and medical history, the patient’s list of current medical providers/suppliers, and the patient’s written screening schedule
Screen for cognitive issues
Provide health advice and referrals as needed