Annual Wellness Visits

Making the Most of the Year-End Push

As year-end approaches, many practices accelerate Annual Wellness Visit (AWV) outreach and scheduling to close preventive-care gaps. Completing eligible AWVs can support more than patient engagement: in many value-based arrangements, AWV completion is tied to quality performance, risk-identification workflows, care-gap closure, and, in some contracts, shared savings or incentive payment opportunities.

 

Annual Wellness Visits: The Year-End Push

 

The Medicare AWV is a prevention-planning service, not a routine annual physical. Its purpose is to identify health risks, update the patient’s preventive-care plan, and create or refresh a personalized prevention plan. Medicare explicitly notes that the yearly wellness visit is not a routine physical examination. Often, additional patient education is necessary, as there is no physical exam required.

 

For practices racing to meet end-of-year targets, AWVs are a high-value opportunity to:

  • Capture and update health-risk, functional, behavioral, and social-risk information.
  • Identify and close preventive screening, immunization, and chronic-condition care gaps.
  • Document a current prevention plan and screening schedule.
  • Connect patients with needed follow-up, care management, health education, and community resources.
  • Improve performance in value-based care programs where preventive engagement, quality measures, and attributed-population outreach affect financial results.

The operational message is simple: do not wait for a provider-only appointment model to complete the work.

 

Coding Refresher

Service HCPCS Code  Practical Reminder 
Initial AWV  G0438  Use for the patient’s first AWV; generally billable once per lifetime. 
Subsequent AWV  G0439  Use for follow-up AWVs after the initial service; Medicare permits G0438 or G0439 only once in a 12-month period 
Initial Preventive Physical Examination (“Welcome to Medicare”)  G0402  This is distinct from an AWV and is available during the patient’s initial Medicare Part B enrollment period. 
FQHC IPPE/AWV Encounter  G0468  Used by federally qualified health centers for the applicable bundled FQHC visit that includes an IPPE or AWV. 

 

CMS identifies G0438 as the first AWV and G0439 as subsequent AWVs; neither may be billed more than once within a 12-month period. CMS also lists G0468 for qualifying FQHC IPPE/AWV visits.

 

Use the Whole Care Team

 

Practices do not need to build the AWV around a physician or APP performing a hands-on exam. There is no CMS requirement for a comprehensive physical examination as part of an AWV alone. The required work is centered on a health risk assessment (HRA), preventive planning, risk review, and personalized recommendations, not a head-to-toe exam.

 

This creates an important opportunity to use team-based workflows:

  • Front-desk and outreach staff can identify eligible patients, schedule visits, and distribute or collect pre-visit HRA questionnaires.
  • Medical assistants, nurses, care managers, pharmacists, and other trained clinical staff can complete standardized data collection, vital signs, medication reconciliation, screening tools, functional and fall-risk assessments, and care-gap review, consistent with practice policies and scope of practice.
  • The billing practitioner can review the information, conduct the required assessment and counseling, finalize the personalized prevention plan, and ensure documentation supports the billed service.
  • Care coordinators and community health workers can support referrals, follow-up, and connection to preventive, behavioral-health, and social-support services.

 

CMS states that the HRA may be completed independently by the beneficiary or administered by a health professional before or as part of the AWV. In other words, efficient workflows can shift much of the standardized, preparatory work upstream, allowing the provider’s time to focus on interpretation, clinical judgment, shared decision-making, and the patient’s prevention plan.

 

Practical Year-End Reminder

 

A successful year-end AWV sprint is not simply a scheduling campaign. It is a structured population-health intervention: identify eligible patients, pre-complete the HRA and care-gap review, use staff at the top of their training, ensure clinician review and appropriate documentation, and convert identified needs into timely follow-up. Done well, AWVs advance patient-centered prevention while supporting quality and value-based payment performance.

 

Reference:
Centers for Medicare & Medicaid Services. (2026, February 11). Annual wellness visits.
https://www.cms.gov/training-education/medicare-learning-networkr-mln/compliance/medicare-provider-compliance-tips/annual-wellness-visits