Annual Wellness Visit (AWV)

Definition

The Annual Wellness Visit (AWV) is a Medicare-covered yearly preventive visit that develops or updates a personalized prevention plan for beneficiaries, distinct from the Initial Preventive Physical Examination (IPPE) and from annual physical exams. The AWV is a face-to-face encounter focused on prevention, not problem-based care.

Required elements of the AWV include a health risk assessment, a list of current providers and suppliers, a review of the beneficiary’s medical and family history, cognitive impairment screening, depression screening, a review of functional ability and safety, and a personalized prevention plan with recommended screenings and preventive services. The visit is covered at no cost to the beneficiary when the provider accepts Medicare assignment.

Regulatory basis

The AWV was established by the Affordable Care Act of 2010 (section 4103) and is covered under Medicare Part B. Two HCPCS codes govern billing: G0438 applies to the initial AWV — the first AWV a beneficiary receives after 12 or more months of Medicare Part B enrollment, and is generally billed approximately once per lifetime for a given beneficiary — while G0439 applies to each subsequent AWV, which may be billed every 12 months thereafter.

Authoritative billing and coverage guidance is published by CMS in the CMS MLN AWV chart, which summarizes covered elements, documentation requirements, and coding guidance for both G0438 and G0439.

Who uses it and when it applies

• Medicare Part B beneficiaries who have been enrolled for 12 or more months — the IPPE (Welcome to Medicare) covers the first 12 months, after which the AWV applies
• Physicians and qualifying non-physician practitioners who perform or direct the AWV encounter
• A beneficiary may receive ONE AWV per year, measured on a rolling 12-month basis from the date of the previous AWV
• The AWV is not the same as a routine annual physical exam — Medicare does NOT cover traditional annual physicals; the AWV is a distinct preventive framework that is separately defined and separately reimbursed

Related terms

• Chronic Care Management — often billed alongside the AWV for beneficiaries with multiple chronic conditions
• Transitional Care Management — a post-discharge program distinct from the AWV preventive framework
• Care coordination — the broader function that the AWV’s personalized prevention plan supports
• Patient engagement — the engagement framework that makes the AWV’s prevention plan actionable between annual visits

How Positive Check relates

Positive Check supports post-AWV prevention-plan execution: daily wellness calls can reinforce the screenings, lifestyle changes, and follow-up appointments documented in the AWV’s personalized prevention plan, keeping patients engaged year-round rather than only at the annual visit. Learn more about how Positive Check complements care programs on the chronic care management solutions page.