Did you know that only 25% of Medicare-eligible patients utilize their Annual Wellness Visit (AWV)? This is a clear underutilization, not just for the patient but also for healthcare clinics and providers. For practices all over the country, proper capture and billing of preventive services such as the Medicare Annual Wellness Visit improves both revenue as well as compliance metrics.
This guide by Providers Care Billing LLC is designed to help by explaining everything clinicians need to know about Annual Wellness Visits, including applicable CPT codes, examples, optimal billing strategies, and more.
What is the Annual Wellness Visit?
The Annual Wellness Visit (AWV) enables professionals to discover particular health indicators, health risks, along with the medical and family histories of patients. The AWV physically examines a patient not thoroughly. Rather, it examines wellness, and it specifically plans for prevention. AWV medical treatments, as opposed to standard wellness appointments, give attention to the patient’s physical health in conjunction with their psychological and emotional stability. The AWV lets physicians raise care levels, engage patients, and maximize their financial potential.
Who Is Eligible?
- Participants in Medicare Part B who have been enrolled in Part B for more than a year.
- The availability of the AWV is once in 12 months.
- A Medicare AWV or Initial Preventive Physical Examination (IPPE) must not have been performed on the patient within the first 12 months.
CPT Code for Annual Wellness Visit
Let’s get straight to the matter: What is the CPT code for the Annual Wellness Visit?
Most frequently used CPT, along with HCPCS codes for AWVs, are the following codes for AWVs.
G0402 —Initial Preventive Physical Exam
This code involves the Welcome to Medicare visit, often called an IPPE. This test is useful for gaining knowledge of the structure that an AWV program. However, it is distinct from an Annual Wellness Visit. Only those people who enroll in Medicare for the very first time are then eligible for up to 12 months. This one-time appointment focuses on acquiring a general picture of health through a vision screening, vital measures, and other tests. If you use this code beyond the 12-month registration period for your Medicare patients, it will be denied.
G0438 — Initial Annual Wellness Visit
A patient is eligible for it after 11 months of enrolling in Medicare. This applies to individuals who are unable to attend their scheduled Initial Preventive Physical Examination. The patient must still complete the Initial Annual Wellness Visit even if they complete an Initial Preventive Physical Examination. An optional cognition test and end-of-life planning are also included in this review.
G0439 — Subsequent Annual Wellness Visit
It is the annual continuation of the first annual wellness visit. Based on their current state of health, patients can attend these visits 11 full months following the Initial Annual Wellness Visit to adjust and continue their preventative care plan.
Add-On Codes (Optional but Important)
- G2211 – Comprehensive Primary Care (During a Medicare patient’s E&M visit)
- 99497 – Advance care planning (can be added to AWV with patient consent)
How One Clinic Improved AWV Billing
For an internal medicine office in Ohio, the staff noticed they were under-billing AWVs due to using the code 99397 (routine physical) instead of G0438/G0439. This issue was fixed after a billing audit from Providers Care Billing LLC.
What was the outcome? In less than two quarters, approved Medicare reimbursements increased by 28%.
✅ This proves that utilizing appropriate HCPCS codes for Medicare wellness visits has significant implications for your practice finances.
What Does the Annual Wellness Visit Include?
CMS standards state that an AWV consists of:
- An evaluation of health risk assessments (HRA)
- Examining medical and family history
- Current medicines and providers listed
- Blood pressure, height, weight, and BMI Blood pressure, height, weight, and BMI are important risk factors to assess during the Medicare visit.
- Evaluation of cognitive impairment
- Screening for depression
- Assessment of functional ability and safety
- Creating or revising a customized preventative strategy
Why the Right CPT Code Matters
Using the wrong code can result in:
- Claim denials
- Lower reimbursements
- Compliance risks
- Missed revenue
Using codes G0438 and G0439 appropriately helps strengthen the payer and medicare patients’ relationships while ensuring correct payments are made.
Documentation Tips for Medicare’s Annual Wellness Visit Billing
To meet CMS criteria and pass an audit, your documents must record:
- Completion of HRA
- Signed the prevention plan with date
- Time spent notated (important for advance care planning)
- Consent form for any additional services rendered
💡 Pro Tip from Providers Care Billing LLC: If your MAC requires it, include your patient’s HRA with the claim submission.
Strategic Billing: Increase Service Value Through Integration
Looking for an ethical way to boost your practice revenue through Medicare patients? Pair AWV with:
- Advance Care Planning (99497)
- Depression Screening and Assessment(G0444)
- Screenings for alcohol misuse (G0442) and obesity counseling (G0447)
Remember to:
- Get patient consent.
- Prevent duplicate billing.
- Understand if the additional service incurs a copay
🎯 Want to make sure your AWV claims are accurate and optimized for faster approvals?
Contact Providers Care Billing LLC today for a free billing audit.
📞 Call Now: 888-495-3786
📧 Email: Info@providerscarebilling.com
Compliance, Audit Protection & Reimbursement
Claims submission is only the beginning of correct CPT coding. It defines how well a provider streamlines their revenue cycle and remains audit-compliant.
At Providers Care Billing LLC, we assist clinics and physicians with:
- Staying current with CMS guidelines
- Avoid both overcoding and undercoding
- Receive full reimbursements as per contract terms
- Train personnel on documentation compliance
- Handle denial and rejection outcomes effectively
Final Thoughts: Trust and Revenue Growth Start with Accurate CPT Billing Coding
The Annual Wellness Visit (AWV) presents opportunities for practices to enhance preventive care delivery as well as improve profitability, which can be achieved if billed correctly and thoroughly documented. A good understanding of the required codes, especially G0438 and G0439, is important.
Whether you are a clinic, solo practitioner, or part of a medical group, don’t leave revenue on the table. Contact the professionals at Providers Care Billing LLC so you can concentrate on patient care after expert guidance through Medicare wellness visit billing.
If your wellness visit documentation includes symptoms like headaches, understanding how to accurately code them with ICD-10 Code R51.9 is essential for supporting your claims.
FAQs
- Is the AWV comparable to a yearly physical exam?
No. The AWV does not replace a comprehensive head-to-toe physical examination. The yearly physical CPT codes: 99381-99397 are never covered services under the Medicare Annual Wellness Visit guidelines.
- Who is capable of performing the AWV?
The AWV can be performed by the following health care professionals: a physician who is a doctor of medicine or osteopathy, physician assistant (PA), nurse practitioner, certified clinical nurse specialist, or medical professional, including a health educator, registered dietitian, nutrition professional, or other licensed practitioner, or a team of medical professionals working under the direct supervision of a physician.
