What must be included in an Annual Wellness Visit?
Quick Answer
An Annual Wellness Visit (AWV) must include seven core components to meet CMS billing requirements for G0438 (initial AWV, ~$175) or G0439 (subsequent AWV, ~$282): (1) Health Risk Assessment (HRA) questionnaire completed by the patient, (2) review of medical and family history, (3) list of current providers and suppliers, (4) measurement of height, weight, BMI, blood pressure, and other routine measurements, (5) detection of cognitive impairment, (6) review of functional ability and safety (fall risk, hearing, activities of daily living), and (7) establishment or update of a written personalized prevention plan including screening schedule for the next 5-10 years. The AWV is NOT a physical examination. It is a preventive planning visit focused on health risk identification and prevention scheduling. Common billable add-ons during the AWV include depression screening (G0444, ~$18), alcohol misuse screening (G0442, ~$18), and advance care planning (99497, ~$86). NPIxray analysis shows AWV completion averages only 38% of eligible Medicare beneficiaries nationally, representing significant missed revenue and CCM enrollment opportunity for most practices.
Health Risk Assessment (HRA) Requirements
The Health Risk Assessment is the foundation of the AWV and must be completed by the patient either before or during the visit. CMS requires the HRA to collect information on: demographic data (age, gender), self-assessment of health status, psychosocial risks (depression, stress, social isolation), behavioral risks (smoking, alcohol use, physical activity, diet, seatbelt use), activities of daily living (ADLs) including dressing, bathing, walking, and instrumental ADLs (meal preparation, shopping, medication management), and patient safety risks (fall history, home safety). The HRA can be administered as a paper questionnaire, a tablet-based form in the waiting room, or a digital form sent to the patient before the visit via patient portal. Pre-visit completion is recommended to maximize face-to-face time for counseling. CMS does not mandate a specific HRA form, allowing practices to use any validated instrument that covers the required domains. Many EHR systems include built-in AWV templates that incorporate the HRA requirements. The HRA results should be documented in the medical record and reviewed with the patient during the visit.
Medical History and Provider Review
The AWV requires a comprehensive review and update of the patient's medical and family history, including: past medical and surgical history, current medications with dosages (medication reconciliation), family medical history relevant to preventive care decisions, a list of all current healthcare providers and suppliers involved in the patient's care (physicians, specialists, DME providers, home health agencies), and immunization history with recommendations for needed vaccines. For the initial AWV (G0438), this review is more extensive as it establishes the baseline. Subsequent AWVs (G0439) focus on updating the existing record. The provider list is a frequently overlooked requirement. CMS wants documentation that the practice has identified all providers involved in the patient's care to facilitate care coordination. This also serves as an excellent lead-in to CCM enrollment, since patients seeing multiple providers for chronic conditions are likely CCM-eligible. Document the review in structured format within your EHR. Many practices use AWV-specific templates that include fields for all required elements, ensuring nothing is missed during the visit.
Screening and Assessment Components
Three screening areas are mandatory during every AWV. Cognitive Assessment: detect any cognitive impairment using a validated screening tool. Common options include the Mini-Cog (2-3 minutes), Montreal Cognitive Assessment (MoCA, 10-12 minutes), or structured patient/informant observations. If impairment is detected, document findings and plan for further evaluation. CMS does not mandate a specific instrument. Functional Ability and Safety: assess the patient's ability to perform daily activities, evaluate fall risk (history of falls, balance assessment, home safety), screen for hearing and vision impairment, and review home safety concerns. The Timed Up and Go test is a quick fall risk screening tool. Depression Screening: while not technically mandatory as part of the AWV itself, depression screening (PHQ-2 or PHQ-9) is separately billable as G0444 (~$18) and should be performed routinely. Similarly, alcohol misuse screening (AUDIT-C or CAGE) is billable as G0442 (~$18). These add-on screenings increase per-visit revenue by $36 and improve quality metrics. Document all screening results, positive and negative, with the specific instruments used.
Personalized Prevention Plan
The Personalized Prevention Plan Schedule (PPPS) is the hallmark deliverable of the AWV and must include: a list of risk factors and conditions for which primary, secondary, or tertiary interventions are recommended, a screening schedule for the next 5-10 years based on USPSTF guidelines and patient risk factors, recommended preventive services and immunizations, and referrals to health education programs, lifestyle interventions, or community resources. For the initial AWV (G0438), the PPPS is created from scratch. For subsequent AWVs (G0439), it is updated based on new findings and completed screenings. Specific screening recommendations should be personalized: colonoscopy schedule based on age and risk factors, mammography recommendations, lung cancer screening for qualifying patients, diabetes screening, and cardiovascular risk assessment. The PPPS also serves as a roadmap for scheduling future preventive visits, creating a retention mechanism for the practice. Document the PPPS in the medical record and provide a copy to the patient. Many practices use this document as the foundation for CCM care plans when patients qualify.
Revenue Optimization and Add-On Billing
The AWV itself generates $175-$282 depending on initial vs subsequent visit. However, strategic add-on services can double the revenue per AWV encounter. Separately billable add-ons: depression screening G0444 (~$18), alcohol misuse screening G0442 (~$18), advance care planning 99497 (~$86) for discussing living wills, healthcare proxies, and end-of-life preferences, tobacco cessation counseling 99406/99407 ($14-$28), and structured cognitive assessment 99483 (~$258) when cognitive impairment is detected. If clinical problems are identified during the AWV that require medical decision-making, a separate E&M visit (99213-99215) can be billed on the same day with modifier 25, adding $75-$150 to the encounter. A maximized AWV encounter can generate $400-$600+ in a single visit. NPIxray analysis of 1,175,281 providers shows national AWV completion rates average only 38% of eligible Medicare beneficiaries. Increasing AWV volume is one of the fastest revenue improvements available: schedule 10 additional AWVs per month at $282 each, and annual revenue increases by $33,840, plus the downstream CCM enrollment opportunities from newly documented chronic conditions.
Frequently Asked Questions
Is the AWV a physical exam?
No. The AWV is a preventive planning visit, not a physical examination. It focuses on health risk assessment, screening, and prevention planning. A separate problem-oriented E&M visit can be billed on the same day with modifier 25 if clinical issues are addressed.
Who can perform an AWV?
Physicians, physician assistants, nurse practitioners, and clinical nurse specialists can perform and bill AWVs. Some components (HRA, vitals, screening questionnaires) can be performed by clinical staff under supervision.
How often can a patient have an AWV?
The initial AWV (G0438) can be performed 12 months after the patient's Welcome to Medicare visit or initial Medicare enrollment. Subsequent AWVs (G0439) can be performed annually, at least 12 months after the previous AWV.
Is there a copay for AWV?
No. The AWV is a covered preventive service with no patient copay, coinsurance, or deductible under Medicare Part B. This makes scheduling easier since there is no cost barrier for patients.
See Your Practice's Specific Numbers
Enter any NPI number to instantly see missed revenue from E&M coding gaps, CCM, RPM, BHI, and AWV programs — based on real CMS Medicare data.
Scan Your NPI