While the core purpose of the Annual Wellness Visit (AWV) remains the same, CMS is sharpening its focus on prevention, risk assessment, and care coordination. Here’s a clear breakdown of what changed, what stayed the same, and how to make the most of these visits.
The Big New Addition: Physical Activity and Nutrition Assessment
Starting January 1, 2026, Medicare covers a standardized physical activity and assessment as part of the AWV, which can be billed using code G0136 every six months. The semi-annual billing frequency is what makes this addition particularly valuable. Unlike the AWV itself, this assessment gives providers a touchpoint with patients around lifestyle factors that directly influence health outcomes.
This aligns with CMS’s ongoing push to embed preventive and lifestyle-focused services more deeply into primary care. If you’re already having conversations about diet and exercise during wellness visits, this assessment formalizes and compensates you for that work.
Reimbursement Rates Are Up
CMS did not make any major structural changes to AWV program rules in the 2026 Final Rule, but reimbursements did increase. Check the CMS Physician Fee Schedule tool for exact rates in your area.
A Reminder on the Basics
The AWV is not a traditional annual physical. It focuses on a structured health risk assessment, screening schedule, and counseling rather than a comprehensive physical exam.
The 3 AWV Codes:
- G0402 – Welcome to Medicare visit, available during a patient’s first 12 months of Part B enrollment.
- G0438 – Initial AWV, available 12 months after an IPPE, or after 11 months of Medicare enrollment if the patient missed the IPPE window.
- G0439 – Subsequent AWVs, billed annually after the initial visit.
| Payer | AWV | Physical Exam | Frequency |
| Traditional Medicare | Covered | Not Applicable | Every 12 Months |
| Medicare Advantage | Covered | Covered | Yearly, Any Time |
| Commercial | Not Applicable | Covered | Yearly, Any Time |
Required Documentation for every AWV includes:
A standardized Health Risk Assessment, review and update of medical and family history, a list of current providers and suppliers involved in the patient’s care, routine measurements, a cognitive impairment assessment, a depression risk evaluation, and a review of functional status, fall risk, safety at home, and sensory issues.
Add-on Services Still Available
The AWV remains a strong platform for services that benefit patients and generate additional reimbursement.
- Advanced Care Planning (CPT 99497): When ACP is completed with an AWV, it is entirely covered for the patient. This is an optional service but a clinically valuable one, especially for older or high-risk populations.
- Social Determinants of Health Risk Assessment (G0136): When the SDOH assessment is provided on the same day as a covered AWV by the same provider, CMS waives both the coinsurance and deductible.
Telehealth Remains an Option
AWVs (both G0438 and G0439) may be provided via telehealth. The 2026 Physician Fee Schedule makes many telehealth expansions permanent, and direct supervision for some services can now occur virtually through audio-video technology.
Billing an AWV Alongside a Problem-oriented Visit
Medicare will pay a physician for an AWV and a medically necessary E/M service furnished during a single encounter. Physicians must bill G2211 (office/outpatient evaluation and management visit complexity add-on) with AWV-related codes.
The new physical activity and nutrition assessment is the headline change this year, and its semi-annual billing cadence makes it worth building into AWV workflows from the start. Higher reimbursement rates across all three AWV codes makes 2026 a good year to grow an existing AWV program or launch one.