The Medicare Wellness Visit is a preventive health service designed to help beneficiaries stay healthy and plan for future healthcare needs. This visit is not a traditional physical exam but a structured consultation focused on risk assessment and creating a personalized prevention strategy. Convenience is a concern for many beneficiaries, leading to the question of whether this important check-up can be completed remotely, such as over the phone.
Current Rules for Telehealth Wellness Visits
The ability to conduct a Medicare Wellness Visit remotely has expanded, especially following flexibilities introduced during the public health emergency. Medicare now covers the Annual Wellness Visit (AWV) via telehealth, including both audio-video and, in specific circumstances, audio-only (phone) communication. These flexibilities allow non-behavioral health services, including the AWV, to be provided to patients in their homes through at least January 30, 2026, without previous geographic restrictions.
Interactive audio-video technology is the preferred standard, but audio-only visits for the AWV are permissible under certain conditions. This is allowed if the provider can use an audio-video system, but the beneficiary is either not capable of using the video technology or does not consent to its use. The patient must also be in their home for this audio-only exception to apply. Providers must document the reason for using an audio-only format to ensure compliance with federal guidelines.
For billing, providers use specific codes (G0438 for the initial AWV and G0439 for subsequent ones) along with a telehealth modifier. Even when conducted over the phone, the provider must adhere to all state and federal regulations regarding patient privacy and security. These temporary waivers make it easier for beneficiaries to access this preventive service from home, removing transportation or mobility barriers.
Distinguishing Between the Types of Wellness Visits
Medicare covers two distinct types of preventive visits, both of which can be furnished via telehealth. The first is the Initial Preventive Physical Examination (IPPE), commonly known as the “Welcome to Medicare” visit. This is a one-time benefit available only within the first 12 months after a beneficiary enrolls in Medicare Part B.
The IPPE focuses on health promotion and disease prevention, including a review of medical and social history, and is not a comprehensive physical examination. After the first 12 months of Part B enrollment, beneficiaries become eligible for the Annual Wellness Visit (AWV). The AWV is available once every 12 months and updates the personalized prevention plan established in the initial visit. Both the IPPE and the AWV are distinct from a routine annual physical, which Medicare Part B does not cover.
Core Components of a Wellness Visit
Whether conducted in person or over the phone, the Medicare Wellness Visit must include several mandatory components. A central requirement is the completion of a Health Risk Assessment (HRA), a questionnaire that gathers information about a patient’s health status, injury risks, and behavioral health. This assessment helps the provider identify potential health risks and social determinants that may impact the patient’s well-being.
The visit must include the following core elements:
- A thorough review of the patient’s medical and family history.
- A complete list of all current medications, including over-the-counter supplements.
- Establishing or updating a list of all current healthcare providers and suppliers involved in the patient’s care.
- A mandatory screening for cognitive impairment, using observation or validated tools.
- The development or update of a personalized prevention plan, including a written screening schedule for the next five to ten years and health advice.
Cost and Frequency of Coverage
A benefit of the Medicare Wellness Visit is that it is covered at 100% by Medicare Part B, meaning the beneficiary typically pays nothing. There is no copayment, coinsurance, or deductible applied for the visit itself, provided the healthcare provider accepts Medicare assignment. This full coverage applies to both the one-time Initial Preventive Physical Examination and the subsequent Annual Wellness Visits.
The frequency of coverage is strictly limited to one AWV every 12 months. A common point of confusion is the distinction between the preventive service and any diagnostic services performed during the same visit. If a provider addresses a new health concern, performs a physical exam, or orders diagnostic tests, these are considered separate services. Such diagnostic or treatment-related services may be subject to the standard Part B deductible and coinsurance, potentially resulting in unexpected out-of-pocket costs.