Annual
Wellness Visits

As defined by the Centers of Medicare & Medicaid Services (CMS), an annual wellness visit is a healthcare visit, either in-person or virtual, designed to provide Personalized Prevention Plan (PPP) services and perform a Health Risk Assessment (HRA). Annual wellness visits are offered to patients at no cost to them and are covered once every 12 months.

The purpose of a patient’s first annual wellness visit providing Personalized Prevention Plan (PPP) services is to establish an individual’s medical and family history, as well as take stock of their measurements, risk factors and functional abilities.

Annual wellness visits benefit patients by furnishing personalized health advice, providing preventive counseling services and practicing community-based lifestyle inventions to reduce health risks and promote self-management. AWVs also benefit practices by enabling a holistic understanding of their patients to improve satisfaction and health outcomes.

An annual wellness visit is not a yearly or routine physical that patients may get periodically from their physician or other qualified healthcare professionals. Medicare does not cover routine physical exams.

The main component included in a patient’s first annual wellness visit is the Health Risk Assessment (HRA). The HRA must include, but is not limited to, the following criteria: a self-assessment of health status and physical functioning, psychosocial and behavioral risks, and activities of daily living.

Annual wellness visits do not include clinical lab tests, but healthcare professionals may make appropriate referrals for these tests as part of AWV services.

After the first annual wellness visit, each subsequent visit involves reviewing and updating the Health Risk Assessment (HRA), the patient’s medical and family history, the list of current providers and suppliers, measurements, cognitive impairments, risk factors, and screening schedule.

To receive reimbursements for annual wellness visits, you must report a diagnosis code when submitting AWV claims. The four HCPCS codes through a AWV program include the Welcome to Medicare AWV (G0402), then the initial visit (G0438), subsequent visits (G0439), and visits conducted by federally qualified health centers (G0468). Refer to CMS.org for the latest CPT code updates.

Most practices only have 40% coverage when it comes to annual wellness visits for Medicare patients. Medsien can help you get to 90% coverage of your AWV eligibility with no changes to your workflow nor additional time from your providers or staff. Reach out to our team of AWV experts today to get started.

Not maximizing AWV program coverage can result in leaving money on the table. Request a demo to learn how Medsien can help you achieve 90% coverage without incremental administrative work.