Annual Wellness Visit

Medicare provides coverage for an Annual Wellness Visit (AWV) for HMSA's Akamai Advantage® members who have had Medicare Part B coverage for 12 months and have not received an Initial Preventive Physical Exam (IPPE) within the past 12 months. HMSA will cover one initial Annual Wellness Visit (G0438) per lifetime and one subsequent Annual Wellness Visit (G0439) per calendar year. G0438 and G0439 cannot be used in the same calendar year.

Medicare pays for one initial AWV (HCPCS G0438) per member per lifetime. A member may receive subsequent AWVs (HCPCS G0439) per calendar year after the year following the initial visit. Please note that an AWV is not a routine physical checkup or follow-up visit.

Effective 1/1/2024, Medicare added the Social Determinant of Health (SDOH) Risk Assessment (HCPCS code G0136) as an additional element of the AWV. The SDOH Risk Assessment has the same frequency limitations as AWV when performed together.

The medical record must document the performance of the following required components:

• Review of a health assessment [PDF].
• Establishment of an individual's medical/family history.
• Measurement of an individual's height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements as deemed appropriate, based on the member's medical/family history.
• Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.
• Detection of any cognitive impairment that the individual may have.
• Review of an individual's potential risk factors for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression.
• Review of an individual's functional ability and level of safety based on direct observation, or the use of appropriate screening questions or a screening questionnaire which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations.
• Establishment of a written screening schedule for the individual, such as a checklist for the next 5 to 10 years. A copy must be given to the member.
• Establishment of a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an IPPE or previous AWV, and a list of treatment options and their associated risks and benefits.
• Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self-management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.
• Furnishing of a review of any current opioid prescriptions.
• Screening for potential substance use disorders including a review of the individual’s potential risk factors for substance use disorder and referral for treatment as appropriate.
• Any other element determined appropriate through the national coverage determination process.

In subsequent years, these required components should be updated.

For more information:

• Medicare Wellness Visits educational tool
• Medicare Preventive Services educational tool
• Chapter 18 - Medicare Claims Processing Manual [PDF]
• Information for your patients on “Welcome to Medicare” preventive visit and Yearly Wellness Visit
• Medicare Star Ratings webpage - see "Provider Tools" for HRA, COA tools, sample emails, and more

Revision History