What do I need to do for an annual Medicare wellness exam?

Medicare Annual Wellness Visit Requirements

The Medicare Annual Wellness Visit (AWV) is a structured preventive care encounter that requires a health risk assessment, cognitive function evaluation, personalized prevention plan, and screening for key geriatric conditions—not a traditional physical examination. 1, 2

Core Required Components

Health Risk Assessment (HRA)

• A formal Health Risk Assessment must be completed to guide further screening and evaluation 2
• The HRA should assess medical risks, drug use, lifestyle and health habits, functional status, cognitive status, mobility, mental health, and end-of-life planning 2
• This structured assessment differentiates the AWV from the initial Welcome to Medicare visit 2

Cognitive Function Assessment

• Cognitive evaluation is a mandatory component of the Medicare AWV and provides an opportunity to discuss brain health with patients 1
• Use a brief structured cognitive assessment tool such as the Mini-Cog, Montreal Cognitive Assessment (MOCA), Memory Impairment Screen (MIS), or AD8 (Alzheimer Disease 8-Item Informant Interview) 1
• The Alzheimer's Association recommends an algorithm involving patient observation, unstructured questioning, and if signs/symptoms are present, a brief structured assessment 1
• Informant-based questionnaires like the AD8 or Alzheimer's Questionnaire (AQ) are particularly valuable for detecting cognitive decline 1

Personalized Prevention Plan

• Create an individualized wellness plan for health promotion for the next 5-10 years 2
• The plan should address identified health risks from the HRA 2
• Include screening recommendations, immunizations, and cancer screenings appropriate for age and risk factors 3

Physical Examination Requirements

Minimal Physical Exam

• Blood pressure measurement is the only required physical examination component 2, 4
• No comprehensive physical examination is mandated by Medicare for the AWV 4
• Height, weight, and BMI calculation should be documented 2

Optional Assessments

• Vision screening can be incorporated 3
• Functional status assessment including mobility evaluation 2
• Falls risk assessment is recommended for geriatric patients 2

Screening and Preventive Services

Review Health Maintenance Gaps

• Assess and address gaps in immunizations (influenza, pneumococcal, shingles, Tdap) 3
• Review age-appropriate cancer screenings (colorectal, breast, cervical, lung if indicated) 3
• Document completion rates of preventive services 3

Medication Review

• Comprehensive medication reconciliation 2
• Assessment for polypharmacy and potentially inappropriate medications in older adults 2

End-of-Life Planning

• Discussion and documentation of advance directives 2
• Assessment of patient preferences for future care 2

Practice Implementation Strategies

Team-Based Approach

• Delegate different components to various team members to improve efficiency 2
• Medical assistants or nurses can collect vitals, perform vision screening, and administer the HRA during check-in 3
• Providers focus on cognitive assessment, prevention planning, and counseling 2

Time Allocation

• Adequate time must be allocated for the visit—typically 30-45 minutes 2
• Group Medicare wellness visits are a feasible alternative model that patients find satisfying, though effectiveness compared to standard care requires further study 3

Documentation and Billing

• All required elements must be performed, documented, and billed correctly to generate appropriate revenue 2
• The AWV can be financially beneficial for practices when properly executed 2

Common Pitfalls to Avoid

• Do not perform a comprehensive physical examination—this wastes time and is not required or reimbursed 4
• Do not skip the cognitive assessment despite time constraints—it is a mandatory component 1
• Do not rely solely on patient self-report for cognitive function; use structured tools or informant-based questionnaires 1
• Avoid scheduling AWVs during acute illness visits—these are separate encounters 2
• Do not fail to create and document the personalized prevention plan 2

Key Distinctions

The AWV differs fundamentally from traditional annual physical examinations, which have limited evidence of value 1. The AWV focuses on risk assessment, prevention planning, and early detection of geriatric conditions rather than comprehensive physical examination 2. This represents a paradigm shift toward structured preventive care in older adults 1.