What the Annual Wellness Visit is
The Annual Wellness Visit is a yearly Medicare Part B benefit focused on prevention and planning, not on a physical exam. It centers on a Health Risk Assessment, a patient questionnaire covering health status, behavioral and psychosocial risks, and function, and it produces or updates a personalized prevention plan with a screening schedule for the next five to ten years. CMS covers the visit at no cost-sharing when the provider accepts assignment, and the Part B deductible does not apply.
Required elements include the Health Risk Assessment, a medical and family history, a current providers and medications list, routine measurements, a review of depression risk, a check for cognitive impairment, a functional and safety assessment, and personalized health advice with referrals.
The codes: G0438 and G0439
The AWV is billed with two HCPCS codes, not the standard office-visit codes:
- G0438 for the initial Annual Wellness Visit, the first one a patient ever receives.
- G0439 for every subsequent Annual Wellness Visit after the first.
Only one of the two is payable in a 12-month period. The first AWV cannot fall within the first 12 months of Part B coverage, and it cannot be billed within 12 months of the one-time "Welcome to Medicare" Initial Preventive Physical Examination (G0402). A significant, separately identifiable problem-oriented visit can be billed the same day with modifier 25.
AWV vs annual physical
This is the most common point of confusion. The AWV is a covered preventive-planning visit with no hands-on comprehensive exam. A traditional annual physical, a head-to-toe exam, is not a Medicare-covered benefit, so a patient who wants one pays out of pocket. They are different services, documented and billed differently. The AWV is also distinct from the once-in-a-lifetime "Welcome to Medicare" visit, which is only available in the first 12 months of Part B.
Why the AWV is the risk-adjustment keystone
The AWV is the one annual, no-cost, structured touchpoint that pulls a whole panel into the office. Because the assessment forces a full look at chronic conditions, it is the natural moment to re-document active HCC diagnoses so they recapture for the year and to identify suspected conditions for confirmation, which protects a member's RAF score. It is equally the prime care-gap closure moment: the mandated screening schedule surfaces open gaps such as mammography, colorectal screening, kidney evaluation, and depression screening, which map directly to HEDIS and Star measures. The capture itself happens in the paired problem-oriented visit, billed with modifier 25, not on the G0438 or G0439 line.
How Pelica makes the AWV count
About four in ten beneficiaries miss the AWV in a given year, and even completed visits often leave gaps and diagnoses unaddressed. Pelica works that gap from both sides: outreach and scheduling to get members in, pre-visit preparation that surfaces open gaps and suspected conditions for the clinician, and post-visit documentation checks so the work actually recaptures. Across deployments, Pelica has surfaced more than 9,000 AWV opportunities with documentation attached, turning a low-effort visit into measurable risk and quality lift.
Related terms
See HCC and RAF for the risk-adjustment capture the AWV supports, HEDIS measures for the gaps it surfaces, and the risk adjustment solution for how capture moves upstream to the point of care.