The Medicare Annual Wellness Visit (AWV) is a yearly preventive service designed to help Medicare beneficiaries stay healthy by creating a personalized prevention plan. Because the AWV is a non-physical examination focused on assessments and planning, current Medicare rules allow it to be performed using telehealth technology. This virtual option expands access for those who may have difficulty traveling to a clinic, allowing patients to review their health status and plan for the coming year from the convenience of their home.
Eligibility and Current Coverage Rules for Telehealth AWVs
Medicare Part B covers the Annual Wellness Visit at no cost to the beneficiary, meaning there is typically no copayment, coinsurance, or deductible. This coverage applies whether the service is performed in person or through a virtual appointment. To be eligible, a patient must have had Medicare Part B for more than 12 months and not have received an AWV or the one-time “Welcome to Medicare” Preventive Visit within the past year.
The ability to conduct the AWV via telehealth relies on the nature of the visit, which is primarily conversational and assessment-based. For most services provided via telehealth, Medicare requires the use of synchronous audio and video communication. However, flexibility may be allowed for audio-only visits if the patient does not have access to video technology, ensuring accessibility for all beneficiaries. Providers must obtain the patient’s virtual consent to conduct the visit using telehealth and document this consent in the medical record.
Essential Components of the Virtual Visit
The virtual AWV must cover the same comprehensive requirements as an in-person visit to meet Medicare guidelines. A primary focus is the completion of a Health Risk Assessment (HRA), which is a questionnaire that gathers information about the patient’s health status, injury risks, and behavioral health.
The provider will also conduct a thorough review of the patient’s medical and family history, as well as their current list of healthcare providers and medications. Furthermore, a cognitive assessment is required to check for signs of cognitive impairment, often involving screening questions and direct observation of the patient’s behavior during the video visit. The AWV also includes screening for depression and assessing the patient’s functional ability, such as their risk for falls or issues with activities of daily living.
The culmination of the virtual visit is the creation or update of a personalized prevention plan of service (PPPS). This plan outlines recommended health and lifestyle changes, such as diet or exercise, and establishes a written screening schedule for appropriate preventive services over the next five to ten years. Optional elements, like advance care planning, are also easily incorporated into the virtual conversation.
AWV vs. Comprehensive Physical Exam: Scope Limitations
A common misunderstanding is confusing the Medicare Annual Wellness Visit with a comprehensive hands-on physical examination. The AWV is fundamentally a planning and risk-assessment service, not a head-to-toe physical. Unlike a physical exam, the AWV does not require the provider to perform a hands-on assessment of the body, such as listening to the heart or lungs, checking reflexes, or performing an abdominal exam.
While routine measurements like blood pressure, height, and weight are technically required components, they can often be self-reported by the patient or deferred during a telehealth visit. If the provider identifies a specific symptom or concern during the virtual AWV that requires a physical assessment or lab work, a separate, follow-up, in-person visit would be necessary.
This distinction is important because the follow-up visit to address new or chronic medical problems is billed separately and may incur a deductible or copay, unlike the preventive AWV. The AWV is designed to be a proactive conversation about prevention and care coordination, focusing on long-term wellness rather than acute medical issues.