What are the requirements for a Medicare Annual Wellness Visit in 2026?

The requirements for a Medicare Annual Wellness Visit (AWV) in 2026 depend on whether you are completing your initial visit or a subsequent annual visit.

Eligibility Requirements

• Part B Enrollment: You must be enrolled in Medicare Part B.
• Timeframe: You must have had Part B for at least 12 months.
• Prior Visits: You cannot have had an AWV or a "Welcome to Medicare" visit within the past 12 months, and it cannot occur in the same calendar year as your "Welcome to Medicare" visit (HCPCS G0402).

Core Visit Requirements & Components

According to guidelines from the Centers for Medicare & Medicaid Services, the visit includes these essential elements:

• Health Risk Assessment (HRA): A written or electronic questionnaire completed by you or your provider covering your health status, psychosocial risks (such as depression, stress, and loneliness), and behavioral risks (such as alcohol use, tobacco use, and nutrition).
• Routine Measurements: Height, weight, body mass index (BMI), and blood pressure checks.
• Medical and Family History Review: Documenting your past medical and surgical history, current medications/supplements, and the medical events of your parents, siblings, and children.
• Current Provider & Supplier List: Reviewing the list of current providers and medical/durable equipment suppliers involved in your care.
• Cognitive Impairment Screening: A brief assessment to check for memory loss, confusion, or early signs of dementia.
• Functional Ability & Safety Evaluation: Screening for fall risk, hearing impairments, and your ability to perform activities of daily living (ADLs) and home safety.
• Depression & Mood Screening: Assessing your mental health and psychosocial status.
• Personalized Prevention Plan (PPP): Creating or updating a written 5-to-10-year screening and vaccination schedule based on your age and health risks.
• Advance Care Planning: An optional, patient-led conversation about your future medical care preferences.

Initial vs. Subsequent Visit Codes

• Initial Annual Wellness Visit (HCPCS G0438): For beneficiaries who have passed their first 12 months of Part B coverage (or finished their Welcome to Medicare exam) and are doing their first comprehensive AWV.
• Subsequent Annual Wellness Visit (HCPCS G0439): For beneficiaries who have already received an initial AWV in a prior year; requires updating the HRA, medical/family history, and your prevention plan.

What the AWV Is Not

• Not a Physical Exam: The AWV is a conversation- and risk-assessment-based planning session. It does not include a head-to-toe physical examination (such as listening to your heart/lungs or performing reflex and neurological tests).
• Not for Diagnosing New Problems: If your provider diagnoses, treats, or manages new or existing acute illnesses during the visit, those extra evaluations or lab tests may be billed separately, and regular Part B deductibles or coinsurance may apply. The AWV itself is covered at $103/$0 out-of-pocket (100% covered by Medicare Part B) if your provider accepts assignment.

Medicare covers an annual wellness visit once every 12 months, meaning at least 11 full months must pass between your previous visit and your next one.

Timing Rules

• Original Medicare (Fee-for-Service): Subsequent annual wellness visits typically require at least 11 full months to have passed, and some billing systems measure based on the calendar month (for example, if your last visit was December 21, you can have the next one as early as December 1).
• Medicare Advantage: These plans follow calendar-year rules in some cases, but visits should still ideally be spaced about 12 months apart to ensure smooth coverage.
• First-Year Rules: Your very first annual wellness visit cannot happen within the first 12 months of your Part B enrollment or during the same window as a "Welcome to Medicare" physical.

You can check specific rules or locate your coverage details through the official Medicare Yearly Wellness Visits page.

There is no single official set of three words mandated by Medicare, but commonly cited examples used in short-term recall tests include "banana, sunrise, and chair" or "apple, table, and penny".

About the 3-Word Memory Test

• Purpose: Healthcare providers use a quick word-recall task during the cognitive screening portion of an Annual Wellness Visit to check short-term memory and detect early signs of cognitive impairment.
• How it works: The clinician names three unrelated words, asks you to repeat them, moves on to other discussion or questions, and then asks you to recall the three words a few minutes later.
• Flexibility: Because doctors use different validated screening tools or local clinic guidelines, the exact words chosen change from visit to visit and provider to provider.

A Medicare Annual Wellness Visit does not include a traditional, head-to-toe physical exam or the diagnosis, discussion, and treatment of new or existing medical problems.

Services Not Covered During the Visit

• Detailed Physical Exams: Checking heart, lungs, abdomen, or performing routine physical maneuvers is not part of the Annual Wellness Visit.
• Medical Treatments: Doctors cannot treat acute or chronic illnesses during this preventive appointment.
• Symptom Discussions: Evaluating active health complaints, new aches, or recent injuries is excluded.
• Medication Changes: Providers do not adjust, prescribe, or change drug prescriptions during the wellness evaluation.
• Lab Work and Diagnostics: Routine blood tests, X-rays, EKGs, or other diagnostic biometric testing are not included and cost extra if performed.
• Vaccinations: Administering routine shots is generally billed separately, though the visit will review which vaccines you might need.

The Centers for Medicare & Medicaid Services (CMS) guidelines for a Medicare Annual Wellness Visit (AWV) in 2026 focus on personalized prevention planning, risk assessments, and health status updates rather than a head-to-toe physical examination.

Core HCPCS / CPT Codes & Eligibility

• G0402 (IPPE / Welcome to Medicare): Covered once in a lifetime for new beneficiaries within their first 12 months of Part B enrollment (National average reimbursement: ~$175).
• G0438 (Initial AWV): Available once in a lifetime for patients who have been enrolled in Part B for more than 12 months and have not received an initial AWV or IPPE (National average reimbursement: ~$174).
• G0439 (Subsequent AWV): Billed annually, at least 11 full calendar months after the previous initial or subsequent AWV (National average reimbursement: ~$138).

Key 2026 Updates

• Physical Activity & Nutrition Assessment (G0136): Effective in 2026, a standardized, evidence-based assessment of physical activity and nutrition (lasting 5 to 15 minutes) can be billed using code G0136 semi-annually as an optional element. Add modifier -33 on the claim alongside the AWV to waive the copayment and deductible for this specific code.
• Cost Sharing: The AWV itself remains a $0 preventive service for beneficiaries if the provider accepts assignment. However, addressing acute or new medical issues during the same visit may trigger a separate Evaluation and Management (E/M) charge subject to deductibles and coinsurance (use modifier -25).

Required Documentation Elements

• Health Risk Assessment (HRA): Completed by or on behalf of the beneficiary prior to or during the visit.
• Medical and Family History: Documenting past medical events of parents, siblings, and children, along with hereditary risk factors.
• Current Providers & Suppliers List: A list of regular medical and behavioral healthcare providers.
• Routine Measurements: Height, weight, body mass index (BMI) or waist circumference, and blood pressure.
• Cognitive Impairment Detection: Assessed via direct observation or formal screening instruments.
• Depression & Functional Screening: Reviewing risk of depression, functional ability, fall risks, and home safety.
• Personalized Prevention Plan (PPPS): A written schedule or checklist of recommended preventive services and screenings for the coming years.