Annual Wellness Visits give Providers an opportunity to look beyond today’s concerns and help Medicare Members plan for healthier years ahead.

A Medicare Annual Wellness Visit (AWV) is designed to create or update a personalized prevention plan based on the Member’s health risks and needs. It includes a Health Risk Assessment (HRA) and provides an opportunity to consider the Member’s health goals, chronic conditions, and barriers to care. An AWV is different from an Initial Preventive Physical Examination (IPPE) or routine physical exam.

During an Annual Wellness Visit, Providers can work with the Member and, when appropriate, their caregiver to identify priorities and create a plan for preventive care and overall well-being.

Build a Complete Picture of the Member’s Health

A successful AWV brings together information that can help guide care throughout the year. The HRA may be completed before or during the appointment, but the information should be discussed with the Member and documented.

Providers can use this visit to:

• Review the Member’s medical and family history
• Complete medication reconciliation
• Establish a list of current Providers and suppliers
• Measure height, weight, BMI, and blood pressure, along with other appropriate measurements based on medical history
• Assess cognitive impairment and depression
• Evaluate functional ability, including falls, hearing, vision, and overall safety
• Identify health goals, needed screenings, and immunizations
• Review risk factors, conditions, interventions, and recommendations for care
• Provide personalized health advice and appropriate referrals
• Assess the need for advance care planning

Opportunity to Close Care Gaps

The AWV is also a natural time to identify preventive and chronic care services a Member may need. For example, Providers can check whether a Member is due for colorectal or breast cancer screening or needs HbA1c testing, nephropathy screening, or diabetic retinal screening or monitoring.

If possible, help Members take the next step before the visit ends, such as arranging a needed screening or providing an appropriate referral. This can make the prevention plan more actionable for the Member.

Help Members Prepare

A little preparation can make the conversation more productive. Consider having the Member complete the HRA before the appointment so it can be reviewed in advance. For a telemedicine AWV, the guide also recommends asking Members to have their medications and information about their other Providers and medical service companies available during the appointment.

AWV is Not a Routine Physical

Making this distinction clear can help set expectations with Medicare Members. An AWV focuses on assessing health risks and developing or updating a personalized prevention plan. A routine physical examination is an exam performed without relation to the treatment or diagnosis of a specific illness, symptom, complaint, or injury.

Medicare covers an AWV for Members who have not received an IPPE or AWV within the previous 12 months. The AWV may be an initial or subsequent AWV, but only one can be conducted within a 12-month period.

Code the Visit Correctly

Accurate coding helps MVP recognize the service provided and process the claim correctly. Use the appropriate HCPCS code:

• G0402: Initial Preventive Physical Examination for a new Medicare beneficiary during the first 12 months of Medicare Part B enrollment
• G0438: Initial Annual Wellness Visit, including a personalized prevention plan
• G0439: Subsequent Annual Wellness Visit, including an updated personalized prevention plan
• G0468: Annual Wellness Visit provided by a Federally Qualified Health Center as part of its Medicare-covered service bundle

A diagnosis code is also required and should be consistent with the Member’s exam.

MVP Be Well Rewards

All MVP Medicare Members can earn a $100 reward card after completing an Annual Wellness Visit. MVP uses the claim submitted by the Provider’s office to confirm that the visit was completed. Submitting the claim promptly with the appropriate code helps MVP process the visit and allows the Member to redeem their reward card.

Make Prevention Part of the Plan

An AWV is more than a yearly check-in. It is an opportunity to step back, consider the Member’s overall health and turn identified risks and preventive needs into a personalized plan. By using the visit to address screenings, chronic care needs, safety concerns and health goals, Providers can help Members understand what they can do next to support their health.

For more information, access the AWV Provider Reference Guide.