The Medicare Annual Wellness Visit (AWV) is a preventive service designed to help beneficiaries stay healthy by creating a personalized prevention plan. Unlike a traditional physical, the AWV is a conversation-based assessment focused on risk reduction, not a hands-on physical examination. Telehealth uses electronic communication and information technology to deliver healthcare services remotely, connecting patients with providers through secure video conferencing.
Medicare Coverage for Virtual Annual Wellness Visits
Medicare generally covers the Annual Wellness Visit when conducted via telehealth, meaning beneficiaries can complete this service from home. This flexibility expanded the use of virtual care, recognizing the convenience and safety it offers. The service is reimbursed by Medicare just as if it were performed in person, provided the encounter uses two-way, interactive audio-video technology.
The Centers for Medicare & Medicaid Services (CMS) uses specific Healthcare Common Procedure Coding System (HCPCS) codes to identify these services. The initial AWV is billed using code G0438, and all subsequent annual visits are billed using G0439. When the visit is delivered virtually, providers typically append modifier 95 to the claim to indicate that the service was furnished via telehealth.
Logistics and Technology Requirements
A successful virtual AWV requires secure and compliant technology to protect patient information. Healthcare providers must utilize platforms that adhere to the Health Insurance Portability and Accountability Act (HIPAA), ensuring the confidentiality and security of the electronic exchange. These platforms use end-to-end encryption to create a private communication channel between the patient and the provider. The standing requirement is for a secure, synchronous audio-video connection.
The AWV can be furnished by a variety of qualified professionals, including a physician, a Nurse Practitioner (NP), a Physician Assistant (PA), or a Certified Clinical Nurse Specialist (CNS). Other clinical staff, such as a health educator or registered dietitian, can also perform certain elements of the visit under the direct supervision of a physician. The patient’s location is typically their home, and the claim is generally submitted with Place of Service code 02 to denote a telehealth service. The patient must provide verbal consent for the visit, which the provider documents in the medical record.
Core Components of the Remote Visit
The virtual AWV focuses on updating the patient’s health profile and developing a personalized prevention plan of service (PPPS). A central element is the Health Risk Assessment (HRA), a questionnaire that gathers self-reported information on demographics, health status, psychosocial risks, and behavioral risks like physical activity and tobacco use. This assessment can be completed by the patient beforehand or verbally during the video visit, forming the foundation for the rest of the discussion.
Providers review the patient’s medical and family history, along with current medications, supplements, and healthcare providers. While a hands-on physical exam is not part of the AWV, routine measurements like height, weight, and blood pressure are required. In the remote setting, patients are often asked to self-report these measurements, or the provider may note that measurements were deferred if the patient lacks the necessary home equipment.
The visit also includes screening for cognitive impairment, which can be accomplished through observation and brief verbal screening tools. The provider assesses the patient’s functional ability and safety, including potential fall risks and home environment hazards. Based on all the gathered data, the provider creates or updates the PPPS, which includes a written screening schedule for the next five to ten years and referrals to health education or preventive counseling services.
Preparing for Your Virtual Annual Wellness Visit
To ensure your virtual AWV is productive, taking a few preparatory steps is beneficial. Before the appointment, gather all necessary information, including a detailed list of all prescription medications, over-the-counter drugs, and dietary supplements you are currently taking. This list should include the dosage and frequency for each item.
To maximize the visit, prepare the following:
- Test your technology, including the camera, microphone, and internet connection, before the scheduled time.
- Choose a quiet, well-lit, and private location to ensure confidentiality and minimize distractions.
- Have a pen and paper ready for taking notes or completing simple tasks, such as a cognitive screening test.
- Prepare a list of questions or concerns you want to discuss with your provider.