Annual Wellness Visits
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What's Changed?
We updated the improper payment rate and denial reasons for the 2024 reporting period.
Affected Providers
Physicians and non-physician practitioners who bill for annual wellness visits (AWVs) and a personalized prevention plan of service (PPPS).
HCPCS & CPT Codes
Medicare Preventive Services has the current HCPCS and CPT codes.
Background
According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the overpayment rate for AWVs (including a PPPS subsequent visit G0439) was 24.5%, with a projected overpayment amount of $307.5 million.
Denial Reasons
For a root cause description of overpayment rate errors, see Table L1: Service-Specific Overpayment Rates: Part B.
Preventing Denials
We cover an AWV, including PPPS, if the service meets these requirements:
- The service is performed by a health care provider
- It’s provided to an eligible patient who isn’t within 12 months after their first Medicare Part B coverage period’s effective date, and they haven’t had an initial preventive physical exam (IPPE) or an AWV providing PPPS within the past 12 months
| NOTE: |
|---|
| The IPPE, also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE within the first 12 months the patient has Part B. You can check eligibility to make sure the patient’s IPPE is within their first 12 months of Part B coverage. |
The AWV’s goal is health promotion and disease detection, and it encourages patients to get the screening and preventive services that we may already cover and pay for under Part B. The AWV includes showing, or updating, the person’s medical and family history, height, weight, body-mass index or waist circumference, and blood pressure.
Medicare Wellness Visits has more information on the IPPE, the AWV, and routine physical exams.
Disclaimers
Page Last Modified:
11/25/2025 12:26 PM