Medicare Annual Wellness Updates 

Annual wellness visits (AWV) 

AWV is covered for all Medicare beneficiaries who: 

Are not within 12 months after the effective date of their first Medicare Part B coverage period and 

Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months. 

What’s new 

Effective for dates of service (DOS) on and after January 1, 2026, addition of administration of a standardized, evidence-based assessment of physical activity and nutrition, 5 – 15 minutes, not more than every 6 months has been added as an optional element: 

The billing HCPCS code is G0136. 

Add modifier – 33 to HCPCS G0136, performed on the same claim with the same date of service as the AWV to waive copayment and deductible. 

G0136 is covered once every 6 months when provided with an evaluation and management or behavioral health service on the same claim with the same date of service, in this situation the copayment and deductible apply. 

Effective for dates of service (DOS) on and after January 1, 2024 added information about community health integration (CHI) initiating visit. 

The AWV can be an optional CHI initiating visit when the provider identifies any unmet SDOH needs that prevent the patient from doing the recommended personalized prevention plan. 

HCPCS/CPT codes 

G0438 – Initial visit (once in a lifetime). 

G0439 – Subsequent visit (annually). 

99497 – Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate. 

99498 – Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure). 

Frequency 

Once in a lifetime for G0438 (first AWV). 

Annually for G0439 (subsequent AWV) and G0468 (AWV in FQHC) 

Annually for optional 99497, 99498. 

Deductible and coinsurance for Advance Care Planning is only waived when furnished as an optional element of an AWV, which requires: 

Billing with modifier –33 (Preventive Service) on the same claim as an AWV. 

Furnishing on the same day and by the same provider as the AWV. 

Telehealth options: Ways to improve your Medicare patient’s access to AWV 

Telehealth has the potential to expand access, reduce costs, and improve patient’s health. 

Telehealth (video/audio) can improve access to AWV. 

The CMS List of Telehealth Services allows AWV using the telephone only. 

Notes 

ACP is treated as an optional preventive service when furnished with an AWV. 

Practitioners may provide advance care planning outside of the AWV multiple times in a year, but the practitioner must document a change in the beneficiary’s health for each additional service in a year. When providing advance care planning outside the AWV, the beneficiary is responsible for the deductible and coinsurance. 

Refer to the Medicare Wellness Visits booklet for more information.