Medicare Annual Wellness Visit Required Elements
The Medicare Annual Wellness Visit must include a Health Risk Assessment, review of medical and family history, measurement of vital signs (height, weight, BMI, blood pressure), detection of cognitive impairment, review of functional ability and safety, establishment of a written screening schedule for the next 5-10 years, and a list of current providers and medications 1, 2.
Core Required Components
Health Risk Assessment (HRA)
- This is the distinguishing feature of the AWV compared to other Medicare visits 2
- Must be completed to guide further screening and evaluation
- Can be administered by staff prior to clinician encounter
Medical and Social History Review
The following must be documented:
- Medical history: Current and past conditions, surgical history
- Family history: Age and health status of immediate family members, diseases that may be hereditary
- Psychosocial risks: Depression screening, functional status, safety concerns 2
- Lifestyle factors: Diet, physical activity, tobacco use, alcohol consumption 2
Physical Measurements
Required vital signs include:
- Height and weight (to calculate BMI)
- Blood pressure
- Other routine measurements as clinically appropriate 2
Cognitive Impairment Detection
- Medicare specifically added detection of cognitive impairment to the AWV benefit in 2011 3
- Must assess at least one cognitive domain (memory, attention, language, visuospatial or executive functioning)
- Common screening tools include Mini-Mental State Examination (MMSE with cut-point of 23/24 or 24/25), Clock Drawing Test, Mini-Cog, or Memory Impairment Screen 3
- Clinicians should remain alert to early signs including problems with memory or language 3
Functional Ability and Safety Assessment
Must evaluate:
- Functional status: Activities of daily living, instrumental activities of daily living 2
- Mobility assessment: Fall risk screening is specifically mentioned as a quality metric 4
- Home safety: Ability to observe home environment is noted as a benefit of telehealth AWVs 5
Medication Review
- Complete list of current medications including prescriptions, over-the-counter drugs, and supplements 2
- Review for appropriateness and potential interactions
Provider and Supplier List
- Documentation of all current healthcare providers and durable medical equipment suppliers 2
Personalized Prevention Plan
Must establish a written screening schedule for the next 5-10 years that includes:
- Age and gender-appropriate preventive services
- Risk factor reduction strategies
- Individualized health promotion plan 2
Important Caveats
What Can Be Delegated
- Staff members can perform the HRA, vital signs, and portions of the screening assessments
- This improves efficiency and allows the clinician to focus on interpretation and planning 2, 4
Documentation Requirements
- All required elements must be documented to bill correctly 2
- The visit generates revenue only if requirements are met and properly coded
Timing Considerations
- Adequate time must be allocated - clinicians report needing the full hour for in-depth screenings and holistic care 6
- Combined AWV with problem-based visits shows lower no-show rates (11.9%) compared to AWV-only visits (19.6%) 4
- Continuity with the patient's regular clinician further reduces no-shows (12.5% vs 25.4% with other clinicians) 4
Quality Metrics Captured
When performed comprehensively, AWVs significantly increase screening rates for breast cancer, cervical cancer, colorectal cancer, depression, falls, hepatitis C, HIV, lung cancer, osteoporosis, and diabetes monitoring 4