Annual Wellness Visit (AWV) 101: What It Is and Why It’s Important
Dr. Martinez ends another day feeling frustrated. Almost every appointment was consumed by urgent concerns—adjusting blood pressure medications, interpreting lab results, treating a patient’s new shoulder pain. Preventive care, the kind that could help her patients avoid these issues in the first place, kept getting pushed to “next time.” She wonders: is there a way to create space for long-term health planning, without the pressure of solving acute problems at the same time?
There is—and it’s already built into many patients’ insurance benefits. The **Annual Wellness Visit (AWV)**, available to Medicare beneficiaries and most private insurers, offers a structured, dedicated visit to focus entirely on prevention, risk assessment, and planning for the future. Yet despite its clear value, many practices either underuse it or skip it altogether, leaving a powerful tool for patient health and practice performance untapped.
The AWV is a yearly preventive service designed to develop or update a personalized prevention plan, and it is not a routine physical exam.
What is the AWV?
The Annual Wellness Visit is a yearly preventive service focused on creating or updating a personalized prevention plan. It is not a “head-to-toe physical,” but a structured encounter to identify risk factors, review current health status, and plan for preventive screenings and interventions.
There are two primary types:
- Initial AWV (G0438): For patients new to the benefit—once in a lifetime.
- Subsequent AWV (G0439): For patients who have already had an initial AWV—once every 12 months.
Both types include a Health Risk Assessment (HRA) and may be furnished by a physician (MD/DO), qualified non-physician practitioner (PA, NP, CNS), or a medical professional under direct physician supervision as part of a team.
What happens during an AWV?
An AWV is more than a checklist—it’s a focused conversation and review designed to build a roadmap for the year ahead.
Typical components include:
- Health Risk Assessment (HRA): Completed by the patient before or during the visit, covering medical history, lifestyle, functional status, and psychosocial risks.
- Comprehensive history review: Updating medical and family history, along with current providers and suppliers.
- Measurements: Height, weight (or waist circumference), blood pressure, and other routine measurements informed by patient history.
- Screenings: Depression, fall risk, and cognitive impairment detection using validated tools.
- Review of preventive services and screenings: Identifying gaps in preventive care and aligning them with recommended schedules.
- Personalized prevention plan: A written plan for screenings, lifestyle interventions, and follow-up intervals, provided to the patient in clear, actionable language.
- Advance care planning (optional): When billed on the same day as the AWV, coinsurance and deductible are waived; otherwise, standard cost sharing applies.
Why the AWV matters for patient health
AWVs create a rare and valuable window for comprehensive preventive care—one in which the sole focus is identifying risks, closing care gaps, and setting actionable goals for the year ahead. Without an AWV, these conversations are often fragmented, squeezed between urgent issues.
Consistent use of AWVs:
- Identifies silent risks early. A patient may feel fine yet have uncontrolled blood pressure, be overdue for cancer screening, or exhibit early cognitive changes that are only uncovered through the structured assessments in the AWV.
- Boosts uptake of preventive services. Because the AWV produces a personalized prevention plan, it naturally leads to ordering or scheduling needed screenings and vaccinations.
- Improves chronic condition oversight. Reviewing chronic conditions in a preventive context supports alignment between treatment plans, lifestyle goals, and social support needs.
- Activates patients. A dedicated session for prevention signals importance, increasing the likelihood patients will follow through on recommended actions.
- Protects independence and quality of life. Screening for depression, fall risk, and functional limitations enables earlier interventions that help patients maintain independence longer.
Consider the difference for two patients with identical medical profiles—one who completes an AWV each year and one who does not. The AWV patient is far more likely to be up-to-date on vaccines, screenings, and risk assessments, catching problems earlier and preventing avoidable complications.
Benefits for quality metrics and value-based care
AWVs are strategically important for practices in value-based contracts. Because the visit prompts documentation and closure of multiple care gaps in a single encounter, it can directly improve performance on quality measures like:
- Cancer screening rates (colorectal, breast, cervical)
- Immunization rates (influenza, pneumococcal, shingles)
- Depression and fall risk screening
- Blood pressure and BMI documentation
Higher performance in these areas not only benefits patients but can also drive quality incentives and shared savings.
Financial impact for practices
From a revenue perspective, AWVs represent both a dependable billing opportunity and a catalyst for other reimbursable preventive or chronic care services.
*Rates vary by year, payer, and location.
Example scenario: A practice with 800 eligible patients at a 30% completion rate earns revenue from about 240 AWVs per year. Raising that completion rate to 75%—through proactive outreach and better scheduling—would mean 600 AWVs annually, generating tens of thousands of dollars more in direct reimbursement.
AWVs also indirectly strengthen practice finances by:
- Closing care gaps that trigger incentive payments in value-based contracts.
- Ensuring accurate and up-to-date problem lists, which can support appropriate coding and documentation.
- Building patient loyalty through proactive care, reducing attrition.
Implementation strategy
Here are some key steps to consider when planning the implementation of an annual wellness visit campaign
1. Identify eligible patients. Run EHR reports to flag patients due for an initial or subsequent AWV.
2. Educate patients. Use clear language to explain that the AWV is a preventive planning visit (not a physical exam) and outline the benefits.
3. Optimize scheduling and workflows. Reserve dedicated AWV slots and use team-based care to complete allowable components under supervision.
4. Use standardized templates. Embed CMS-required elements into EHR templates to ensure complete documentation.
5. Close care gaps in real time. Order overdue screenings, provide vaccines, and update care plans during the AWV rather than deferring.
Common pitfalls and how to avoid them
There are some frequent issues encountered by clinics trying to implement AWV without prior experience or know-how:
- Treating AWVs as routine physicals—they are prevention-focused visits.
- Missing required elements—use checklists to ensure the HRA, prevention plan, and screenings are documented.
- Not leveraging staff roles—delegating allowable components increases efficiency.
Compliance and audit readiness
To stay compliant:
- Document all required AWV elements in the medical record.
- Include a completed HRA and a written prevention plan.
- Bill the correct code (G0438 or G0439) and observe frequency limits.
- Follow correct modifier use for ACP billing if done the same day.
- If adding the optional Social Determinants of Health (SDOH) risk assessment (G0136), follow CMS billing requirements.
Conclusion
The Annual Wellness Visit is one of the most effective tools for prevention—and one of the most underused. By dedicating time to risk assessment, care planning, and preventive services, it benefits both patients and practices. Lara Health streamlines AWV delivery by identifying eligible patients, embedding CMS-compliant templates, automating documentation, and producing patient-friendly prevention plans—making it easier to scale without sacrificing quality or compliance.
Every AWV is a chance to see your patients in a different light—not as a list of problems, but as whole people with a year ahead of them and a plan to make it healthier. Book a demo with Lara Health to see how seamless AWV implementation can be.
FAQs
Is the AWV the same as a physical exam?
No. The AWV is a preventive planning visit and does not include a routine physical exam.
Who can perform an AWV?
Physicians, PAs, NPs, CNSs, or other medical professionals under direct physician supervision.
Can AWVs be done via telehealth?
Yes, under current Medicare telehealth rules, AWVs (G0438/G0439) are allowed through September 30, 2025, when requirements are met.
What if a patient refuses certain screenings?
Document the conversation and revisit the discussion in future visits.
How often can patients have an AWV?
Once every 12 months after the initial AWV.
Sources
CMS — Medicare Wellness Visits (MLN6775421)
Medicare.gov — Yearly “Wellness” visits
CMS — Advance Care Planning (MLN909289)
CMS — CY2025 Medicare Physician Fee Schedule Final Rule
HHS — Telehealth Policy Updates
