Medicare Annual Wellness Visit: A Guide for Patients and Providers

Carewell
December 16, 2025
Noah Bennett

The Medicare Annual Wellness Visit helps you and your doctor stay ahead of health problems. It focuses on preventing illness and checking for any new risks each year. During the visit, your doctor looks at your medical history and current medicines. You can also talk about any new health concerns so problems can be caught early.

You also receive a simple, personalized plan with recommended screenings, vaccines, and tips. This will keep you healthy throughout the year. With the right approach, it becomes a valuable tool for managing preventive care effectively.

What is the Medicare Annual Wellness Visit?

Medicare Annual Wellness Visits are yearly checkups for people with Medicare. They help find health risks and update your medical and family history. Your doctor also creates a simple plan to help you stay healthy. An AWV does not involve the same diagnostic and treatment process as a routine physical visit. It is instead focused on prevention, assessment of health risks, and long-term planning.

During the visit, doctors review medications, assess functional ability, and check cognition. During the process, patients discuss lifestyle habits, including nutrition, exercise, and fall prevention. This is organized in a way to ensure proactive care for the patient and a comprehensive health record over time.

Types of Wellness Visits

Medicare provides three types of wellness visits:

Medicare Initial Wellness Visit (IPPE): You can use this service in your first 12 months of Part B. It covers basic health checks and lifestyle tips.
Initial Annual Wellness Visit: It establishes a base for preventive care and risk assessment.
Subsequent Annual Medicare Wellness Visits: It also updates your past health information. Your doctor reviews any changes in your health or memory and adjusts your prevention plan as needed.

It is very important that both the patient and the provider know what a Medicare wellness exam includes and what it does not. It assists in avoiding misunderstandings in charges.

Medicare Annual Wellness Visit Requirements

Eligibility Criteria

To schedule a Medicare annual wellness visit, you must:

Be enrolled in Medicare Part B.
Wait for at least 12 months since your last AWV or since your IPPE.
Fulfill any other requirements of the plan for patients’ Medicare Advantage annual wellness visit.

Some state Medicaid programs provide preventive visits that parallel the AWV, but the details differ by state.

Frequency and Timing

One of the questions is, must the Medicare wellness visits be 12 months apart? Yes, this allows enough time to track changes in health, update prevention plans, and keep records accurate.

Patient Participation

Highly recommended due to its significance, but the Medicare annual wellness visit is not obligatory. The patients can opt out or refuse a Medicare wellness visit without penalties. People who go each year can catch early warning signs of chronic health problems. This helps them update their plan to stay healthy.

Components of Medicare Annual Wellness Visit

The Medicare Annual Wellness Visit has several parts. Each part helps provide complete preventive care. A Medicare annual wellness visit checklist for providers is mostly utilized by providers. It ensures that all required elements are covered.

Past Medication History and Family Medical History

When you update your medical and family history, it becomes easier for doctors to see your risk for genetic and long-lasting illnesses. Providers usually question surgeries, hospitalizations, chronic conditions, and medications.

Medication Review and Provider List

Your doctor will look at all your medicines and supplements. They also review your other care providers to help prevent drug interactions. This is part of the annual wellness visit Medicare process.

Health Risk Assessment

A health risk check looks at your lifestyle, diet, exercise, alcohol and tobacco use, and home safety. It also reviews your mental health and stress to give a full picture of your wellness.

Functional and Cognitive Assessment

A functional check looks at how well you move and how easily you can do daily tasks. It also reviews the safety of your home. Cognitive assessment addresses memory and orientation. Many patients question is the Medicare cognitive test mandatory? The answer to that is that although cognitive screening is a part of the visit, the actual patient engagement in some tests depends on their choice.

Personalized Prevention Plan

The visit concludes with a written individualized prevention plan that addresses the following:

Vaccinations and other suggested screenings
Lifestyle recommendations about diet, exercise, and sleep
Fall and Home Safety Tips
Monitoring and preventive guidance for chronic conditions

This plan is updated each year during next visits, called an annual Medicare wellness visit.

What is and is not a Medicare wellness visit

Included Services

cal annual wellness visit under Medicare would include:

Health risk assessment
History review: medical and family
Assessment of cognition and function
Medication review
Written individualized prevention plan
Depression and safety screenings

These services are part of the Medicare wellness program. The program helps keep long-term health records and track preventive care.

Excluded Services

Services that are excluded from Medicare annual wellness visit include the following:

Full physical examinations
Laboratory work or diagnostic tests
Treatment of pre-existing medical conditions
Management of chronic diseases

Checklist for Medicare Annual Wellness Visit Providers

Many doctors use a checklist during the visit. This makes sure it meets federal rules and everything is properly recorded. It includes:

Component	Information
Eligibility	Medicare Part B enrollment
History of Present Illness	Updated medical and family history
Medications	Over-the-counter and prescription medication review
Functional Assessment	Mobility, ADLs, and home safety
Cognitive Assessment	Memory, orientation, and mental status
Screening	Depression, alcohol consumption, and lifestyle risks
Prevention Plan	Vaccinations, screenings, lifestyle, and chronic disease guidance
Documentation	CPT/ICD-10 codes and patient record

The checklist is also used as a medicare wellness exam checklist for providers to make sure that every step is done methodically. Some providers may register a medicare wellness card summarizing key recommendations.

Medicare Annual Wellness Visit CPT Codes and Billing

Good coding is fundamental to Medicare reimbursement.

CPT Codes

G0438 – Initial annual wellness visit

G0439 – Subsequent annual wellness visit

ICD-10 Codes

Z00.00 or Z00.01, depending on abnormal findings

Medicare Advantage Visits

A Medicare Advantage annual wellness visit uses the same coding. Some plans also offer extra benefits, like wellness programs, fitness rewards, or nutrition advice.

Coverage and Cost

Does Medicare cover annual wellness visits?

Yes. Because Medicare Part B fully covers the annual wellness visit, there is no copay or deductible for the preventive service itself.

Does Medicare cover any other services?

Yes. These added services include lab tests, screenings, or treatments for a new problem, at the same encounter.

Medicare Advantage Coverage

An annual Medicare Advantage wellness visit does indeed cover the same preventive services. Some plans offer extra benefits. These can include nutrition coaching, gym memberships, or online doctor visits.

Annual Wellness Visit Cost

For the eligible patients, an annual wellness visit costs $0. Patients pay only for those services that are not included in the preventive scope.

Annual Wellness Visit vs. Routine Physical Exam

Feature	Annual Wellness Visit	Physical Examination Routine
Purpose	Prevention, risk assessment, planning	Assess current health and symptoms
Coverage	Fully covered by Medicare	Only if medically necessary
Includes	Health history, cognitive/functional assessment, prevention plan	Physical examination, laboratories, imaging, and symptom assessment
Frequency	Once in 12 months	Varies depending on patient needs

Both visits are important. The AWV focuses on prevention and long-term health planning. A routine physical mainly checks for current health problems.

The Medicare Wellness Program Summary:

The Medicare Wellness Program focuses on preventive treatment and proactive observation. AWV includes the following:

Schedules for screening for chronic diseases like diabetes, hypertension, and heart conditions
Vaccination tracking and recommendations
Fall prevention and home safety guidance
Nutrition and physical activity counseling

Patients may be given a Medicare wellness card that outlines recommendations to adhere to throughout the year.

FAQs

What is not covered in the annual wellness visit of Medicare?

The visit does not include physical exams, lab tests, diagnostic tests, or treatment for current health problems. It is strictly designed for prevention and risk assessment.

Are Medicare wellness visits required?

No, participation in AWV is solely on a voluntary basis. Patients can choose not to go, but attending helps keep prevention steps up to date and monitored.

How is the Medicare annual wellness visit different from a routine physical?

An AWV focuses on preventive care, health risks, and planning. A routine physical checks current symptoms, includes a full exam, and may have lab tests or treatments.

What does a Medicare wellness exam cover?

A Medicare wellness exam reviews your health, medical history, medicines, and any changes since your last visit. It also includes health screenings, safety checks, and a personalized plan to help you stay healthy.

Can you refuse a Medicare wellness visit?

Yes, it is penalty-free for patients to opt out, but foregoing visits can mean lost chances for preventive care.

Do Medicare wellness visits need to be 12 months apart?

Yes, Medicare requires at least 12 months between visits to stay compliant and track care correctly.