The medical acronym AWV stands for the Annual Wellness Visit, a specific preventive health benefit offered through Medicare. This appointment is designed to proactively assess a patient’s health over the long term, focusing on disease prevention and health promotion. The goal is to create a formal, structured plan that helps patients and providers collaborate on maintaining well-being and identifying future health risks.
Defining the Annual Wellness Visit (AWV)
The Annual Wellness Visit is a yearly benefit provided under Medicare Part B, and its fundamental purpose is to establish or update a personalized prevention plan. This visit is structured as a planning session, focusing on evaluating health risks and strategizing preventive measures, rather than a diagnostic or treatment appointment for new or existing conditions. The AWV serves as a systematic way to address gaps in care and promote a value-based approach to health management. The Centers for Medicare & Medicaid Services standardize the visit to ensure a comprehensive review of a patient’s overall well-being. The initial visit is billed using code G0438, while subsequent yearly updates are typically billed with code G0439.
What Happens During the Visit
The AWV begins with the completion of a Health Risk Assessment (HRA), often a questionnaire covering health status, injury risks, behavioral risks, and psychosocial needs. This comprehensive assessment helps the provider understand the patient’s current lifestyle and potential areas of concern. Routine measurements are taken, including height, weight, body mass index (BMI), and blood pressure, to establish objective baseline data.
A detailed review of the patient’s medical history, family history, and a complete list of current prescriptions, including over-the-counter medications and supplements, is also a required component. The visit involves several key screenings and discussions:
- Screening for cognitive impairment, looking for signs of conditions like dementia or Alzheimer’s disease.
- Evaluation for depression and other mental health conditions.
- Discussion about fall risk and home safety.
- Review of pain severity and non-opioid treatment options for patients on opioids.
The central outcome is the creation or update of the personalized prevention plan. This plan includes personalized health advice and a schedule for appropriate preventive services, ensuring the patient receives all recommended screenings and necessary immunizations based on age and risk factors. Discussions about advance care planning, which involves documenting preferences for future medical treatments, are also a standard part of the visit.
Who Qualifies for an AWV
The Annual Wellness Visit is a benefit available to individuals enrolled in Medicare Part B. To be eligible for the first AWV, a patient must have been enrolled in Part B for longer than 12 months. This rule ensures that a patient’s initial period of coverage is complete before accessing the yearly wellness benefit.
A person cannot receive an AWV within the same 12-month period as their “Welcome to Medicare” preventive visit, which is a one-time benefit provided during the first year of Part B enrollment. After the first AWV, subsequent visits are covered once every 12 months.
The benefit is generally covered at 100% by Medicare Part B, meaning the patient pays nothing out-of-pocket, provided the healthcare provider accepts assignment. This coverage applies across both Original Medicare and Medicare Advantage plans.
AWV Versus a Comprehensive Physical Exam
The Annual Wellness Visit is frequently confused with a traditional comprehensive physical exam, but they serve distinctly different purposes in a patient’s care. The AWV is fundamentally a planning session focused on health promotion and risk assessment. It is primarily a discussion-based appointment that reviews data and creates a future-focused prevention plan.
In contrast, a comprehensive physical exam is a hands-on, diagnostic evaluation focused on the patient’s current health status. A physical typically includes a full-body examination, where the provider listens to the heart and lungs, palpates the abdomen, checks reflexes, and examines the ears, nose, and throat. These hands-on elements, along with diagnostic services like blood tests and lab work, are explicitly not required components of the AWV and are often billed as separate services if performed.
A key distinction is the handling of new or acute symptoms. The AWV is not meant to diagnose or treat current illnesses. If a patient presents with a new health concern or needs management for a chronic condition during an AWV, that portion of the visit is considered a separate, billable service, which may incur a deductible or copayment. The physical exam, however, is designed to address and manage both acute and chronic health issues.