AWV: Annual Wellness Visit
The Annual Wellness Visit (AWV) is a Medicare preventive benefit that funds a personalised prevention plan and health risk assessment — not a comprehensive physical exam — for eligible Medicare beneficiaries once every 12 months.
What is the Annual Wellness Visit?
Introduced by the Affordable Care Act in 2011, the Annual Wellness Visit (AWV) is a Medicare Part B benefit designed to help physicians and patients develop or update a personalised prevention plan. Critically, the AWV is not a comprehensive physical examination — Medicare specifically prohibits billing both an AWV and a problem-focused E&M visit on the same day using the AWV code unless a separately identifiable significant medical issue is addressed, in which case a modifier 25 E&M may be billed concurrently.
AWV Billing Codes and Reimbursement
- G0402: Welcome to Medicare Preventive Visit (Initial Preventive Physical Examination — IPPE). One-time benefit within the first 12 months of Medicare Part B enrollment. ~$170 reimbursement.
- G0438: First AWV — patient must not have had an AWV or IPPE in the past 12 months. ~$196 reimbursement.
- G0439: Subsequent AWV — every 12 months thereafter. ~$147 reimbursement.
AWVs have $0 patient cost-sharing — no deductible or copayment — making them one of the most accessible Medicare preventive services and an important patient engagement tool.
Required AWV Components
Required elements include: Health Risk Assessment (HRA), review of medical/family history, establishment of a list of current providers, height/weight/BMI/blood pressure, detection of cognitive impairment, depression screening (e.g., PHQ-2/PHQ-9), functional ability and safety screening, and development/update of a Personalised Prevention Plan (PPP) including a 5–10 year screening schedule.
The AWV Revenue Cascade
The AWV's greatest financial value is not the G0438/G0439 reimbursement itself but the cascade of services it generates: care gap closures (colorectal cancer screening, mammography, diabetic eye exams), CCM enrolment conversations, HCC coding opportunities from systematic problem list review, RPM candidacy identification, and advance care planning documentation. Studies show that patients who complete an AWV generate 22–30% more in total annual revenue than matched non-AWV patients.