Laboratory Tests and X-rays for Medicare Annual Wellness Visit
The Medicare Annual Wellness Visit (AWV) does not specifically require or include any laboratory tests or x-rays as part of its standard components. 1, 2, 3
Core Components of Medicare AWV
- The AWV was established in 2011 as part of the Patient Protection and Affordable Care Act to provide preventive health benefits to Medicare beneficiaries 1
- The AWV focuses on health risk assessment, creating personalized prevention plans, and screening for geriatric syndromes rather than laboratory testing 1, 3
- The visit provides an opportunity for clinicians to review preventive health recommendations and make appropriate referrals for necessary testing based on individual risk factors 1
Recommended Assessments During AWV
- Health risk assessment including review of medical and family history 4
- Blood pressure measurement at every visit 4, 5
- Height, weight, and BMI calculation 4
- Cognitive impairment assessment using structured tools 6, 7
- Depression screening 4, 5
- Functional ability and safety assessment 4
- Personalized health advice and referral to health education or preventive counseling services 8
Laboratory Tests to Consider Following AWV
While not part of the AWV itself, providers may recommend appropriate laboratory tests based on individual risk assessment. Common recommendations include:
- Complete blood count (CBC) to screen for anemia, infection, and blood disorders 5, 9
- Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 5, 9
- Lipid profile to assess cardiovascular risk 5, 9
- Hemoglobin A1C to screen for diabetes and prediabetes 5, 9
- Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 5, 9
- Thyroid-stimulating hormone (TSH), particularly for women and older adults 4, 9
Imaging Considerations Following AWV
- No routine x-rays are required as part of the Medicare AWV 1, 2
- Imaging studies should be ordered based on specific clinical indications identified during the AWV 4
- Abdominal ultrasonography may be recommended once for men aged 65-75 years who have ever smoked 5
- Bone densitometry may be appropriate for postmenopausal women and men age ≥50 years with risk factors 5
Common Pitfalls to Avoid
- Ordering unnecessary laboratory tests or x-rays without specific clinical indications can lead to overdiagnosis and increased healthcare costs 9
- Failing to distinguish between the AWV (which does not include laboratory testing) and a comprehensive physical examination 2, 3
- Missing opportunities to identify patients who would benefit from specific screening tests based on their risk factors 9
- Not considering patient-specific factors such as medication use that might necessitate specific monitoring (e.g., vitamin B12 levels for patients on metformin) 5, 9
Key Takeaway
The Medicare AWV is designed as a preventive service focused on health risk assessment and prevention planning rather than laboratory or radiographic testing. Any laboratory tests or imaging studies should be ordered separately based on individual risk factors and clinical judgment following the AWV assessment.