FAQ

Billing

• What Is a Medicare Annual Wellness Visit?

  A Medicare Annual Wellness Visit (AWV) is a preventive service designed to help you stay healthy over time. Rather than a hands-on physical exam, this visit focuses on prevention, identifying potential risks, and creating a personalized plan for your care.

  During this visit, your care team will:
  • Complete a health risk assessment
  • Review your medical and family history
  • Screen for cognitive concerns
  • Screen for depression
  • Check your blood pressure
  • Create a personalized plan, including recommended screenings and vaccines

  If you are new to Medicare, you may also be eligible for a one-time “Welcome to Medicare” visit, also called the Initial Preventive Physical Exam (IPPE). This visit is available within your first 12 months of enrolling in Medicare Part B and helps establish a baseline for your health.

  Medicare Part B typically covers both the one-time “Welcome to Medicare” visit and yearly Annual Wellness Visits at no cost to you. These visits do not usually require a copay or deductible. However, coverage can vary depending on your specific insurance plan, so it is always a good idea to confirm details before your appointment.

• What is a Physical Exam?

  A Physical Exam is an evaluation of your general health. During this visit, your provider checks vital signs and examines major body systems to assess how your body is functioning.

  This visit may also include reviewing your medical history, discussing preventive care, and addressing any concerns you might bring up. It is a more hands-on assessment than a Medicare Annual Wellness Visit and may include additional services based on your individual health needs, such as screenings or lab work. Depending on why they are ordered, some tests or lab work may not be considered preventive services and may be billed separately.

• What is an Office Visit?

  An Office Visit is designed to evaluate, diagnose, and treat a new or existing medical condition. This type of appointment is appropriate if you are experiencing symptoms, need help managing a chronic condition, or require medication adjustments.

  Examples include concerns like new pain, illness, or follow-up for ongoing conditions such as high blood pressure or diabetes.

• Are screenings part of these visits?

  Your provider may discuss recommended screenings during a Physical Exam or a Medicare Annual Wellness Visit (i.e., mammograms, colonoscopies, etc.). The tests themselves are typically scheduled for a later date and billed separately. Preventive screenings are usually covered for Medicare beneficiaries, though coverage may vary depending on the screening and your specific insurance plan.