Unbiased Analysis of Today's Healthcare Issues

Do I need an Annual Wellness Visit?

Written By: Jason Shafrin - Jun• 14•12

The Affordable Care Act (a.k.a. Health Reform, Obamacare) mandates that Medicare provide an annual wellness visit (AWV) to all beneficiaries free of charge.  Today, I answer some questions related to CMS’s implementation of the mandated annual wellness visit requirement.

What is included in an annual wellness visit?  The AWV includes “the establishment of, or update to, the individual’s medical and family history, measurement of his or her height, weight, body-mass index (BMI) or waist circumference, and blood pressure (BP), with the goal of health promotion and disease detection and fostering the coordination of the screening and preventive services that may already be covered and paid for under Medicare Part B.”  Care coordination is also a key component of the AWV.  The AWV should establish a list of current providers and suppliers that are regularly involved in providing medical care to the individual.  Depression screening, review of the individual’s functional ability, and verifying whether the patient has received preventive care recommendations (as defined by the USPSTF and ACIP).  Additional information on the services provided during an AWV is available here.

Who can provide an annual wellness visit?  Providers eligible to provide an AWV include doctors of medicine or osteopathy, physician assistants, nurse practitioners, or clinical nurse specialists.  Other medical professionals (e.g., health educator, dietitian) can conduct the AWV under supervision of an MD or DO.

 What is a PPPS?  Beneficiaries who see a physician for their AWV receive Personalized Prevention Plan Services (PPPS).  The PPPS are the services the physician is required to provide during the AWV.

How much does an AWV cost patients?  Unlike typical physician visits covered by Medicare Part B, the patient is not responsible for any coinsurance or Part B deductibles.

I am a provider.  How do I bill Medicare for an AMV? There are two HCPCS codes one can use to bill Medicare depending on whether this is the beneficiary’s first wellness visit or not:

  • G0438: Annual wellness visit, including PPPS, first visit
  • G0439: Annual wellness visit, including PPPS, subsequent visit

Are all Medicare beneficiaries eligible for an AWV?  The answer is no.  Newly enrolled beneficiaries are not eligible for a wellness visit; only beneficiaries who have been enrolled in Medicare Part B for at least 12 months are eligible for a wellness visit.  New enrollees, however, are eligible for the new enrollees are instead eligible for the Initial Preventive Physical Exam (IPPE) which is billed under HCPCS G0402.

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  1. […] the ACA, seniors are entitled to an annual wellness exam with no out-of-pocket costs to the patient. Megan Golles highlighted to importance of proper […]

  2. David Wilson says:

    Two additional comments: The AWV is a perfect opportunity to have your healthcare provider review your personal health record since ALL the work is done during the AWV anyway, second, don’t get confused between the IPPE (intro to Medicare) and the AWV. They are similar but different with different billing codes!

  3. Frank Brumley says:

    I just had the Medicare wellness exam. I found it to be an invasion of my privacy. My Doctor which I have regular exams knows what I need from head to toe. All this AWV is a way the government can catalog information about you for their use to interfere in your constitutional rights. You notice this was generated by Obamacare not the people. I will refuse this test from now on. The government has no business in my personal affairs.

  4. Deborah Smith says:

    I have participated in the Medicare annual wellness visit in 2013 and 2014 and I saw it as a waste of my time and an invasion of my privacy.

    I contacted Medicare.gov online and asked them if the annual Medicare wellness visit was mandatory. The Medicare representative had me hold for a few minutes and then came back with an answer; she said that the annual Medicare Wellness visit is not mandatory.

    I then phoned my Medicare HMO and asked a representative if the annual Medicare visit was mandatory or not and I was told it was not mandatory.

    My doctors office phoned me at home to schedule the 2015 annual Medicare wellness visit and I informed them that I had talked to Medicare and my HMO and both told me that the annual Medicare wellness visit is not mandatory so I would not be participating in anymore wellness visits in the future.

    One week later I received a letter from my doctor telling me that if I did not make an appointment for my annual Medicare wellness visit and keep the appointment, that he would be dropping me as a patient due to me not being non-compliant with his instructions. He further said that “your HMO holds me accountable for making sure that you have an annual Medicare wellness visit each year and if you do not call and make an appointment for your wellness visit I will be forced to drop you was a patient.”

    I was forced to make and keep an appointment for this wellness visit that is not considered mandatory. Is there anything I can do about this other than switch to another family doctor. If the annual Medicare wellness visit is not considered mandatory, then patients should have the option to opt-out of the annual Medicare wellness visit. I suspect that this doctor wants the money that Medicare pays him for the annual Medicare wellness visit and that is the only reason he wrote me the letter telling me that he would drop me as a patient if I didn’t participate in the wellness visit.

  5. Janet Murray says:

    I also was forced to endure a “Subsequent Wellness visit” which the nurse practitioner insisted is mandatory. She made a point of telling me I must schedule yet another appointment for a PAP and physical “which will NOT be free.”
    I agree the Wellness visit is a total waste of time and an invasion of my privacy.I was insulted by her comments (I’m not the one making the government rules, etc.)This visit had been scheduled by me for a physical with PAP test,and anticipated standard blood work, mammogram and bone density tests. The latter two were scheduled and completed. However, the blood work turned out to be just for my thyroid function (take med for that) and not all of the usual blood work done which probably means I’ll have at least two more medical appointments that should have been taken care of at the initial discussed appointment.
    I believe Ms. Smith is correct – the doctors want to drop us medicare patients as they see us as less than charity cases. Disgusting!!!

  6. j.flesch says:

    This is absolutely insane. I was told this was mandatory and it’s not. After my review, the nurse printed my report and it was full of inconsistencies: I am 59 inches tall, 110 lbs – report says 48 inches and obese with BMI of almost 34. BP: Usually normal. They took the latest of 164/82 when I was sick with infection. I was told to drink 8 glasses of water a day. I walk 30 minutes every day. I was told to do more, much more, etc..etc.. (I am 79 yrs old). Give me a break.

  7. Jim says:

    This is total bull shot.I have 6 doctors and a dentist who take care of everything I need and I see them on a regular basis.my pc who is a good doctor but greedy seems to
    benefit the most ….the get an average of $160 per visit
    Just say NO

  8. WN says:

    Yep. Same thing. “‘ You can’t be a patient here with Medicare without participating in the Wellness Exam. If you don’t then we get fined.”

    If that is true then the government punishes our health care provider if we view it as not mandatory and opt out. With threats of punishment going on it seems the wording “not mandatory” is a lie. And if it really were a “wellness exam” then they would test for infammation. The name “wellness” is a cover. How about calling it what it is “A Data Collecting Appointment for the Government”?

  9. DM says:

    I refuse to schedule a Wellness visit and have stopped scheduling annual physicals because all they want to do is ask questions that are none of their business so they can provide counseling that I neither need nor want. I understand that the physicians’ practices are scored on whether they collect this information, but that is their problem. I go to specialists – a cardiologist, endocrinologist. and dermatologist – for my care because they do not require all this screening nonsense. If a physician threatened to drop me because I refused to schedule a Wellness visit I would drop that physician and look for another or just use specialists.

  10. […] the ACA, seniors are entitled to an annual wellness exam with no out-of-pocket costs to the patient. Megan Golles highlighted to importance of proper […]

  11. Sigmund Derman says:

    I am a physician who focuses on neurodegenerative diseases of aging, especially dementias. In some cases the annual wellness visit can be helpful. In particular, for some, the included screen for cognitive function could pick up an early dementia. But, on the other hand, those screens are often done poorly and they can cause needless worry.

    At present there is a lot of emphasis on collecting population based health statistics and various types of demographic information. Overall, this is probably beneficial. But, this is not suitable for everybody. The patient should have the ability to refuse any test or treatment offered by the physician, particularly in cases in which the patient is clearly competent and the test or treatment is not vital to save life or protect from other serious harms.

    All of the “required” Medicare screens have a place for the doctor to indicate refusal by the patient and I am sure that gets the doctor off the hook. I would use your own judgement concerning whether you need the wellness screen or any subset thereof. In particular, the screen for cognitive function could unnecessarily cast doubt upon your competence and feed you into a chain of seemingly never ending tests and appointments. These might be helpful. But they might be harmful. I wish there were a definite answer to this, but there is not.

    With respect to the cognitive testing, if you, your loved ones, your colleagues, or your friends are noticing serious lapses in your memory, thinking, or judgement then perhaps you should consider such a screen. Or perhaps you should go directly to a psychiatrist, psychologist, or neurologist who focuses on that area. But I would be careful about undergoing such a screening just because it is free. It may help you. It may hurt you. It may do neither. Doing neither is probably most likely. Decide for yourself but, nonetheless, be open to the advice of those who know you well and love you.

  12. Cory says:

    I also refusing in-home wellness assessment because it is insulting and degrading and also an invasion to my privacy. If medicare mandates my PC that I must have an- in home wellness assessment from my health insurance carrier I will have to look for another primary care doctor. This group health insurance have too much control over our medical choices and privacy and it all boils down to make this insurance profitable at people’s suffering and invasion of privacy.

  13. David Vacation says:

    My wife and I received a call yesterday from our Doctor saying that we HAD to schedule an appointment for our (first) Annual Wellness visit, even though we’ve never had our “Welcome to Medicare” exam. Regardless, when I told the scheduling Med Assistant that neither Medicare nor United Healthcare had told me an Annual Wellness Visit was Manditory, she insisted it was, and that some of our coverages would be at risk if we didn’t comply.

  14. Kelly Perrone says:

    Someone needs to notify Medicare about these Dr.s that are padding so called “care coordinators” pockets. Nothing more than an invasive data collecting appointment for the government indeed! And no doubt a kickback for the Dr. If mine drops me, so be it. He bleeds me 3 or 4 times a year for an office visit anyway!!!

  15. D.L. Wilson says:

    L. Wilson…I have had 2 annual Wellness Visits. I did not fill out any paperwork like a questionaire ahead of time as video talks about. Two nurses(from other than my MD’s office) did the “visits”.
    They took BP and pulse. Asked questions like have you fallen this year, tripped over rugs, are you depressed and when I truthfully replied “No” to each question they would look at each other and roll their eyes like I was lying. I live with my 15 yo grandson, am female, widowed, was 78 at last visit, walk upright without assist, dress myself,wear a size 12, feed myself, drove myself to the visit, am not on any prescribed meds,people comprehend when I speak and vice versa so I felt like I was really being belittled!!I felt like they were not going to get paid if they didn’t find something to send me to a nursing home. I had read where they could order certain tests and since I had not had an EKG or any type of cardiac workup in over 6 years I asked about that and they both replied in unison-“NO”. I did not see the physician but hadn’t planned on it. I hope these visits are not mandatory. No, I am not on the type of insurance plan that hands out a $50 Visa card for a wellness visit and I wouldn’t go back for $500.I really felt like I was too old to still be on this planet-very invasive. It was not a pleasant experience. I have not asked this MD if he drops patients who refuse this visit.If they can pay patients $50 for a visit, wonder how much Dr is paid and would wonder if they get kickbacks for recommending home health care visits, nursing home admission, etc. One’s MD should know from regular visits if someone is mentally ill or unable to care for self.

  16. Bill S. says:

    I had an AWV two days ago and then stumbled upon this website when I got home while researching more about the “mandatory requirement”

    The comments from other Medicare patients above who went through this incredibly well thought out program to help us through our rapidly deteriorating years were quite interesting but probably didn’t go far enough into the positive side.

    I read the following posted from above: “An invasion of privacy”; “absolutely insane”; “this is total bullshot”; “it is insulting and degrading, an invasive data collecting appointment for the government”.

    I thought wow, it that it? Well stated but lacking in descriptive terms so here’s my take after enduring 45 minutes or so. It was demeaning, humiliating, belittling, minimizing, slighting, offensive, shocking, and especially infuriating! I couldn’t believe I was allowing myself to go through these inane questions, some of which were geared to a 1st or 2nd grader, instead of just getting up and walking out. That’s when I decided to have fun with the remainder of it. (at least for me, not the nurse)

    NURSE: “Your height is 5’8″ and your weight is 176 (clothed) That puts your BMI in a normal range but close to the high side of being overweight. You should be more careful of what you eat and drink and bring your weight down.”

    ME: My weight between 173 and 178 has been exactly the same for the last 45 years. You do realize how important consistency is in good health as opposed to an up and down yo-yo problem experienced by most people, don’t you?

    NURSE: “Well, uhhh, I’m only giving you the BMI index that’s the standard for measuring BMI for a healthy state.”

    ME: “I guess that means every professional football player, baseball player, and other athletes are grossly obese and in horrible shape that require weight loss. By the way, BMI measured by height and weight alone is a poor choice because it doesn’t measure the amount of muscle to fat ratio in the body. There are far better and more accurate ways (which I mentioned in this link}: http://www.medicaldaily.com/body-mass-index-bmi-calculator-healthy-weight-obesity-372852

    You may want to consider your own BMI because from my observation it’s somewhat beyond your limit.”

    NURSE: “Are you currently working?”

    ME: “No”

    NURSE: “Are you retired”?

    ME: “Yes”

    NURSE: “What did you do before you retired”

    ME: ” I worked”.

    NURSE: (pushing a sheet of paper to me with a pen) (1st or 2nd grade instruction) “I’d like you to draw a circle on this piece of paper and then number it the same way as the face of a clock. Then draw the hands on it to reflect a time of 11:10.

    ME: “What? You’ve got to be kidding me, right?”

    NURSE: “No, I really need you to do that”.

    ME: “I’ve never been very good at art so I have a better idea.” (I then get up out of my chair and walk around the desk to her side. I pull up the sleeve to my shirt and show her my watch which has a time of 11:13) I then say, “the watch shows 11:13, so if you go back 3 “ticks” on the dial, it’ll be 11:10. You see that, don’t you”?

    We played a few more games like this and I’m sure she wrote on her notes, hostile patient – needs mental counseling.

    Oh, so what was the positive of this visit? She said at the very end, “well, you don’t have dementia”. I then said “Phew, glad to hear it because I was really worried that I did before I got here.”

    I see the Doctor in 3 weeks where I’ll be telling him there is no way in Hades I’ll EVER subject myself to that again and if there’s no other way, we’ll be parting company after 12 years. And I mean it!

  17. B Lane says:

    My husband’s doctor is telling him these visits are mandatory. When he told her that he was required to see her once a month anyway and that he did not feel he really needed this, she told him if he did not schedule and keep a wellness visit, she would quit giving him his pain medication. He is in advanced stages of lupus erythematosis, has a vertebral fracture in thoracic spine, has cardiac problems with a pacemaker plus several other medical problems. We both question how this doctor could be interested in him as a patient and helping him survive or improve with this attitude. She is holding him hostage to his pain medication. I don’t see how this is ethical and I even wonder if it is legal?

  18. Deidre says:

    ALL drs visits have become humiliating since medicare. Hurts to have lost my BlueCross dr and to have to, resort to seeing a PA(who insists on referring to herself as a “doctor”).Literally, 1 minute after my 1st visit with her, she asked, “Do you smoke”.(1 smoke about 4-5 a day)I answered, “Yes”.Then she closed her eyes,placed her hands on her temples then dramatically opened her eyes and swung her hands out exclaiming, “You have COPD!” A psychic diagnoses? I want a NATUROPATHIC DOCTOR. Canadian’s have that option. Why are we forced to see allopathic drs? Preventable medical injuries, nosocomial infection & iatrogenic deaths are now at an all-time-high. Yet, we’re FORCED to adhere to such dangerous health ‘care’?

  19. JOY says:

    When I left my DR office today, he smiled and said, oh we want a wellness check done. I asked the lady in the office if it was mandantory. She said no, but the Dr suggested it, He knows my history, I”ve been seeing him since the 90″s. She also said that Medicare will not cover the exam, only the paperwork they collect on your visit, The patient will be responsible for the expense of the exam which probably cost as much as your regular visit. I told her NO I wasn’t going to schedule. After I’ve read these other comments,I WILL NOT. I”M 75.

  20. JO says:

    I was told today at the doctors office that it is not mandatory to have this wellness check.The patient must pay for the exam, however the paper work is covered by Medicare. I’m 75, a widow. and on Medicaid. I can hardly get by now,so I won”t schedule this wellness checkup,because of costs and also I’s sure they have all the info the government needs on me. It sounds like a money making deal, to me.

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