Medicare Wellness Visits

Are you a person with Medicare?

This content is for health care providers. If you’re a person with Medicare, visit Medicare.gov.

What's Changed?

We added coverage information about Social Determinants of Health (SDOH) HCPCS code G0136 and an Annual Wellness Visit (AWV) FAQ about changes to HCPCS code G2211.

Preventive Services

Early detection saves lives. Encourage patients to get other preventive services.

The Annual Wellness Visits video helps you understand these exams as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)
Review of medical and social health history and preventive services education.

Covered for new Medicare patients within 12 months of starting Medicare Part B coverage
Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)
Visit to develop or update a personalized prevention plan and perform a health risk assessment.

Covered once every 12 months
Patients pay nothing (if provider accepts assignment)

Routine Physical Exam
Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

Not covered
Patients pay 100% out of pocket

Communication Avoids Confusion

You may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to making sure patients understand why you’re recommending certain services and whether we cover them.

Mental Health Crisis Help

Anyone experiencing a mental health crisis, including a substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting 988lifeline.org. Visit the SAMHSA 988 Partner Toolkit for information and resources.

Disclaimers

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