Medicare Annual Wellness Visits (AWVs) a fantastic risk adjustment tool–but don’t sleep on FFS

If you work in outpatient CDI you might have already reached the conclusion that the Medicare Annual Wellness Visit (AMW) is your friend. You’d be right.

The AWV is first and foremost a tool for preventive screening and health. But it’s also a powerful tool in the arsenal of mid-revenue cycle work.

For Medicare Advantage (MA) patients, the AWV is an opportunity to capture all conditions including those eligible for submission for risk adjustment. Obesity, chronic depression, diabetes, CHF, and other chronic conditions can be recaptured for annual reporting during an AWV.

But let’s not forget about Traditional Medicare Fee-For-Service and physician profee billing. We recently discovered that CMS offers up some good, solid coding and billing advice on its website in these avenues.

Aside: When did the CMS website start getting somewhat user friendly and helpful?

See first link below. To summarize from that:

In addition to rendering payment for base AWV codes G0438/G0439/G0468, CMS also will cover G0136 every six months. The code description of G0136 was revised for 2026 to strip out social determinants of health (SDOH) so take note:

• Prior to Jan. 1, 2026 (original definition, no longer valid): “Administration of a standardized, evidence-based Social Determinants of Health (SDoH) risk assessment, 5–15 minutes, not more often than every 6 months.”
• Current/new definition starting Jan. 1: “Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5–15 minutes, not more often than every 6 months.”

CMS considers the SDOH assessment an optional preventive service elements when provided as part of an AWV. If you do use the assessment, you can bill for it (see MLN Matters article below). From that:

• When you provide the SDOH risk assessment as an additional element of the AWV, report HCPCS code G0136 for the SDOH risk assessment with Modifier –33, with the same DOS on the same claim as G0438 or G0439. MACs will accept and process HCPCS code G0136 as an additional element of the AWV (HCPCS codes G0438 and G0439) based on the Physician Fee Schedule.

This great little FAQ also includes G2211 guidance straight from the source. We wrote about this code recently, here’s what CMS has to say about it when provided in conjunction with an AWV (good news: you can bill this too):

Starting January 1, 2025, you can report HCPCS code G2211 and E/M services (CPT codes 99202–99205 and 99211–99215) billed with modifier 25 only when performed on the same day as:

• Annual wellness visit (HCPCS codes G0438 and G0439)
• Vaccine administration
• Any Part B preventive service provided in the office or outpatient setting, except glaucoma screenings

Give CMS some props. These are good resources, use them! And use your AWVs.

Below are some additional articles on our website that offer some additional great ideas for making them part of your risk adjustment strategy.

References

• CMS, MLN Educational Tool, Medicare Preventive Services: https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#AWV
• CMS, MLN Matters, Annual Wellness Visit: Social Determinants of Health Risk Assessment: https://www.cms.gov/files/document/mm13486-annual-wellness-visit-social-determinants-health-risk-assessment.pdf
• Norwood, Annual Wellness Visits: Heart of a value-based CDI program: https://www.norwood.com/annual-wellness-visits-heart-of-a-value-based-cdi-program/
• Norwood, Rigorous patient scheduling critical to success in a risk adjustment environment: https://www.norwood.com/rigorous-patient-scheduling-critical-to-success-in-a-risk-adjustment-environment/