Georgia Medicare Annual Wellness Visit 2026 Guide

By Brevy Care Team · Last verified May 14, 2026

The Medicare Annual Wellness Visit benefit gives every eligible Georgia Medicare beneficiary the right, once each year beginning twelve months after Medicare Part B enrollment, to a comprehensive preventive visit with a qualified primary care provider focused on health risk assessment, identification of risk factors for chronic disease, cognitive function detection, depression screening, functional ability and safety assessment, review of the beneficiary's personal and family medical history, current medications and supplements, and the creation or updating of a personalized prevention plan that coordinates all the recommended preventive services the beneficiary should receive. The Annual Wellness Visit is among the most-utilized Medicare preventive services and serves as the central coordination point — the gateway and the planning encounter — for nearly every other preventive service in the Medicare benefit framework. The visit is billed under HCPCS G0438 (Annual Wellness Visit, including a personalized prevention plan service, initial visit) for the first Annual Wellness Visit a beneficiary receives after Medicare Part B enrollment, or HCPCS G0439 (Annual Wellness Visit, including a personalized prevention plan service, subsequent visit) for each subsequent annual Wellness Visit, at zero out-of-pocket cost to the beneficiary under the Affordable Care Act Section 4104 preventive services cost-sharing waiver.

The Annual Wellness Visit benefit was created by Section 4103 of the Affordable Care Act (Public Law 111-148, March 23, 2010) and codified as Section 1861(hhh) of the Social Security Act, with an effective date of January 1, 2011. The legislative impetus for the Annual Wellness Visit reflected a particular policy goal of the Affordable Care Act framework: to shift Medicare's preventive services architecture from a collection of disconnected individual screening and counseling benefits into a coordinated annual preventive care encounter that would systematically identify each beneficiary's risk factors, document the beneficiary's preferences and priorities, and produce a personalized prevention plan that mapped recommended preventive services to the beneficiary's specific situation. The Annual Wellness Visit therefore differs structurally from the Initial Preventive Physical Examination (IPPE, sometimes called the "Welcome to Medicare" visit) created earlier under Section 1861(ww) effective January 1, 2005: while the IPPE is a once-in-a-lifetime visit available within the first twelve months of Medicare enrollment, the Annual Wellness Visit is an annually renewable benefit available every year beginning twelve months after Part B enrollment.

The Annual Wellness Visit is structured around eight to ten required components depending on whether the visit is the Initial AWV (the beneficiary's first AWV after the IPPE eligibility period has expired or after the IPPE has been completed) or the Subsequent AWV (each AWV after the Initial AWV). The eight to ten required components reflect a holistic preventive care framework that addresses the beneficiary's medical, functional, cognitive, social, and prevention needs:

First, the Health Risk Assessment (HRA) is a self-administered or provider-administered questionnaire that captures the beneficiary's current health status, health behaviors (tobacco use, alcohol use, physical activity, nutrition), psychosocial status (depression, social support, living situation, stress), functional ability (activities of daily living, instrumental activities of daily living), and safety considerations (falls, home environment, driving). The HRA serves as the primary data input for the personalized prevention plan.

Second, routine measurements including height, weight, body mass index, and blood pressure provide the baseline biometric data for prevention planning.

Third, cognitive function detection has become a particularly important component since the 21st Century Cures Act of 2016 emphasized cognitive impairment detection. Providers may use any structured cognitive assessment tool (Mini-Cog, AD8, GPCOG, or others) or may rely on direct observation and history. Identification of cognitive impairment during the AWV triggers further evaluation including the Medicare-covered cognitive assessment and care plan visit under CPT 99483.

Fourth, depression screening uses a structured tool (PHQ-2, PHQ-9, or other validated instrument). The AWV depression screening overlaps with the Section 1861(ddd) depression screening benefit under NCD 210.9, with the AWV providing the annual screening encounter and NCD 210.9 follow-up counseling for positive screens delivered through Medicare-covered behavioral health services.

Fifth, functional ability and safety assessment addresses the beneficiary's activities of daily living and instrumental activities of daily living, fall risk, hearing impairment, vision impairment, home safety, and other functional considerations relevant to older adult care.

Sixth, the personal and family medical history review documents the beneficiary's prior diagnoses, surgeries, hospitalizations, and family history of conditions with genetic or familial components (cardiovascular disease, cancers, diabetes, dementia).

Seventh, the current providers and suppliers list documents the beneficiary's current healthcare team including primary care physician, specialists, dentist, optometrist, pharmacy, home health agency, durable medical equipment supplier, and other providers, supporting care coordination.

Eighth, the current medications and supplements list documents prescription medications, over-the-counter medications, vitamins, herbal supplements, and other substances, supporting medication review and reconciliation.

Ninth (Subsequent AWV only), review of medical and family history since the prior AWV updates the prior AWV's documentation with any new diagnoses, procedures, or family history.

Tenth, the personalized prevention plan service (PPPS) synthesizes all the AWV's preceding components into a structured prevention plan that includes a written schedule for the next five to ten years of recommended preventive services, identifies any risk factors and conditions that should be the subject of focused intervention, and identifies any treatment options for the beneficiary's existing conditions.

The Annual Wellness Visit may also include the Advance Care Planning (ACP) add-on (CPT 99497) for an additional thirty-minute discussion of advance care planning during or following the AWV. The Advance Care Planning add-on was added effective January 1, 2016 and is covered at zero cost-sharing when furnished during the AWV. Outside the AWV context, Advance Care Planning is covered under standard Part B with applicable cost-sharing.

For Georgia Medicare beneficiaries, the Annual Wellness Visit operates within a state landscape that includes substantial primary care infrastructure delivering AWV. The Georgia primary care delivery network includes major academic medical centers (Emory Healthcare, Wellstar Health System, Piedmont Healthcare, Northside Hospital, Augusta University Health, Atrium Health Navicent, Memorial Health), substantial community primary care across the state, the federally qualified health center network providing primary care to underserved populations, and rural primary care including critical access hospitals and rural health clinics. AWV utilization rates vary across Georgia counties with substantial rural-urban disparities reflecting differential primary care access. Telehealth AWV delivery expanded substantially during the COVID-19 public health emergency and has continued in modified form, providing an important access pathway for rural Georgia beneficiaries.

This guide explains how the Medicare Annual Wellness Visit benefit works statutorily and clinically, what eligibility looks like for a Georgia Medicare beneficiary, what the eight to ten required components entail, how the HCPCS G0438 (Initial AWV) and G0439 (Subsequent AWV) coding framework operates, how the AWV coordinates with the Initial Preventive Physical Examination Welcome to Medicare visit, how the Advance Care Planning add-on CPT 99497 fits into the AWV encounter, how the AWV serves as the gateway and coordination point for the broader Medicare preventive services framework including all Section 1861(ddd) behavioral counseling and screening services, how the AWV coordinates with Medicare diabetes screening under Section 1861(yy), cardiovascular screening under Section 1861(xx), glaucoma screening under Section 1861(uu), and other screening benefits, what telehealth AWV delivery looks like for rural beneficiaries, and what the Georgia AWV delivery landscape provides.

Key Takeaways for Georgia Medicare Beneficiaries

1. Section 1861(hhh) of the Social Security Act, added by Section 4103 of the Affordable Care Act, establishes the Annual Wellness Visit benefit effective January 1, 2011.

2. 42 CFR 410.15 implements the AWV through specific regulations defining frequency, required components, eligible providers, and coding.

3. HCPCS G0438 (Initial AWV) is used for the first Annual Wellness Visit a beneficiary receives. HCPCS G0439 (Subsequent AWV) is used for each annual Wellness Visit thereafter.

4. Annual frequency: The first AWV may be furnished beginning twelve months after Medicare Part B enrollment. Subsequent AWVs may be furnished annually thereafter (eleven months after the prior AWV per CMS billing guidance).

5. Required components include health risk assessment (HRA), routine measurements (height, weight, BMI, blood pressure), cognitive function detection, depression screening, functional ability and safety assessment, personal and family medical history, current providers and suppliers list, current medications and supplements list, review of medical/family history (Subsequent AWV), and personalized prevention plan service.

6. Advance Care Planning add-on (CPT 99497) provides an additional thirty-minute advance care planning discussion at zero cost-sharing when furnished during the AWV.

7. ACA Section 4104 waives the Part B deductible and the 20% coinsurance for AWV. Cost-sharing is zero out-of-pocket.

8. IPPE coordination: The Initial Preventive Physical Examination ("Welcome to Medicare") under Section 1861(ww) is a once-in-a-lifetime visit available within the first twelve months of Medicare enrollment. The Initial AWV is available beginning twelve months after Part B enrollment and the IPPE (if elected) does not preclude the Initial AWV.

9. AWV as gateway to preventive services: The AWV serves as the central coordination point for nearly every other Medicare preventive service. Risk factors and conditions identified during the AWV trigger referrals to Section 1861(ddd) behavioral counseling (alcohol misuse, obesity, CVD, STIs, tobacco cessation), Section 1861(ddd) screening services (depression, HCV, HBV), MDPP for prediabetes, Medicare diabetes screening, cardiovascular screening, cancer screenings (colorectal, mammography, prostate, cervical, lung), and other preventive services.

10. For Georgia beneficiaries, the AWV operates within a state landscape that includes major academic medical centers (Emory, Wellstar, Piedmont, Northside, Augusta University), community primary care across the state, the federally qualified health center network, rural primary care infrastructure, and expanded telehealth AWV delivery providing critical access for rural beneficiaries.

The Federal Framework Underlying the Medicare AWV Benefit

Section 1861(hhh) of the Social Security Act — AWV Authority Added by ACA Section 4103

The statutory foundation is Section 1861(hhh) of the Social Security Act, codified at 42 U.S.C. 1395x(hhh), added by Section 4103 of the Affordable Care Act (Public Law 111-148, March 23, 2010). Section 1861(hhh) establishes the AWV as a covered preventive benefit and defines the required components, eligible providers, and frequency framework.

ACA Section 4103 — Free Annual Wellness Visit

Section 4103 of the Affordable Care Act provides for the AWV as a free annual preventive visit. The legislative intent reflected the broader ACA preventive services framework: shift Medicare's preventive services architecture from a collection of disconnected individual screening and counseling benefits into a coordinated annual preventive care encounter that systematically identifies each beneficiary's risk factors and produces a personalized prevention plan.

42 CFR 410.15 — AWV Implementing Regulations

42 CFR 410.15 implements the Section 1861(hhh) framework through specific regulations defining the AWV's required components, eligible provider types, frequency limits, and coding framework. The regulation distinguishes between the Initial AWV (the beneficiary's first AWV after Medicare enrollment, beyond the IPPE eligibility period) and the Subsequent AWV (each AWV after the Initial AWV).

HCPCS G0438 (Initial AWV) and HCPCS G0439 (Subsequent AWV)

The two AWV billing codes distinguish the first AWV from subsequent annual encounters:

• HCPCS G0438 — Annual Wellness Visit, including a personalized prevention plan service, initial visit.
• HCPCS G0439 — Annual Wellness Visit, including a personalized prevention plan service, subsequent visit.

The codes are used only once each in their respective contexts: G0438 is used once per beneficiary for the first AWV after the IPPE eligibility period, and G0439 is used annually for each AWV thereafter. The Initial AWV requires somewhat more comprehensive documentation than the Subsequent AWV, reflecting the baseline assessment nature of the Initial AWV.

CPT 99497 — Advance Care Planning Add-On

Advance Care Planning was added as a separately billable Medicare service effective January 1, 2016. CPT 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate) provides for thirty-minute advance care planning discussions.

When CPT 99497 is furnished during the AWV with the AWV modifier 33 (preventive service), the Advance Care Planning add-on is covered at zero cost-sharing under ACA Section 4104. Outside the AWV context, CPT 99497 is covered under standard Part B with applicable cost-sharing.

ACA Section 4104 — Cost-Sharing Waiver

Section 4104 of the Affordable Care Act waives the Part B deductible and the twenty percent coinsurance for Medicare preventive services aligned with USPSTF Grade A or Grade B recommendations and specifically designated by CMS. The waiver is effective January 1, 2011. The AWV is among the preventive services covered under the waiver.

21st Century Cures Act 2016 — Cognitive Impairment Detection Emphasis

The 21st Century Cures Act (Public Law 114-255, December 13, 2016) emphasized cognitive impairment detection within the AWV framework. While cognitive function detection was a required AWV component from the original Section 1861(hhh) framework, the 21st Century Cures Act reinforced the importance of structured cognitive assessment and supported the development of the separate Cognitive Assessment and Care Plan visit (CPT 99483) effective January 1, 2017 for beneficiaries identified as cognitively impaired.

The AWV Required Components in Detail

Health Risk Assessment (HRA)

The Health Risk Assessment is a self-administered or provider-administered questionnaire that captures the beneficiary's current health status across multiple domains:

• Health behaviors: tobacco use, alcohol use (incorporating screening tools such as AUDIT-C or SASQ), physical activity, nutrition, sleep, sexual health.
• Psychosocial status: depression (incorporating PHQ-2 or PHQ-9 screening), anxiety, social support, living situation, stress, loneliness.
• Functional ability: activities of daily living (bathing, dressing, toileting, transferring, continence, eating), instrumental activities of daily living (managing medications, finances, transportation, shopping, food preparation, housework).
• Safety considerations: fall risk, home environment hazards, driving safety, firearm safety, advance directives status.
• Chronic disease status: existing chronic conditions, current management, gaps in care.
• Prevention status: which recommended preventive services have been received, which are due.

The HRA serves as the primary data input for the personalized prevention plan. CMS provides guidance on HRA content but does not mandate a specific HRA instrument; providers may use their preferred validated HRA tool.

Routine Measurements

• Height (for BMI calculation and as a baseline for height loss potentially indicating osteoporosis or vertebral fractures over time).
• Weight (for BMI calculation, weight trends, obesity assessment).
• Body Mass Index (BMI) (for obesity screening, MDPP eligibility, IBT for obesity eligibility).
• Blood pressure (for hypertension screening per USPSTF Grade A).

Cognitive Function Detection

Cognitive function detection has become a particularly important AWV component since the 21st Century Cures Act 2016 emphasis. Providers may use any structured cognitive assessment tool or may rely on direct observation and history. Common structured tools include:

• Mini-Cog: brief three-item recall plus clock-drawing test.
• AD8 (Ascertain Dementia 8): brief informant-based screen.
• GPCOG (General Practitioner Assessment of Cognition): brief patient and informant assessment.
• MoCA (Montreal Cognitive Assessment): more comprehensive thirty-item assessment.
• MMSE (Mini-Mental State Examination): classic thirty-item assessment.

Identification of cognitive impairment during the AWV triggers further evaluation including the Medicare-covered Cognitive Assessment and Care Plan visit under CPT 99483, neurology or geriatric medicine referral, and consideration of underlying causes (medication effects, depression, sleep disorders, vascular contributions, neurodegenerative disease).

Depression Screening

Depression screening uses a structured validated instrument. Most commonly:

• PHQ-2: two-item brief screen ("Over the past two weeks, how often have you been bothered by: little interest or pleasure in doing things; feeling down, depressed, or hopeless?"). Positive PHQ-2 triggers PHQ-9.
• PHQ-9: nine-item validated instrument with scoring categories (1-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe).
• GDS (Geriatric Depression Scale): 15-item or 30-item version specifically validated for older adults.

The AWV depression screening overlaps with the Section 1861(ddd) depression screening benefit under NCD 210.9 effective October 14, 2011, with the AWV providing the annual screening encounter and NCD 210.9 framework providing the structure for follow-up counseling for positive screens.

Functional Ability and Safety Assessment

• ADLs (Activities of Daily Living): bathing, dressing, toileting, transferring, continence, eating. Independence in ADLs is a fundamental marker of functional status.
• IADLs (Instrumental Activities of Daily Living): managing medications, finances, transportation, shopping, food preparation, housework, communication.
• Fall risk: history of falls in prior year, gait and balance assessment (Timed Up and Go test if indicated), home environment hazards.
• Hearing impairment: screening question or whisper test; positive results trigger audiology referral.
• Vision impairment: screening question; positive results trigger ophthalmology or optometry referral.
• Home safety: medication storage, fall hazards, fire safety, firearm safety, food security.
• Driving safety: driving status, recent crashes or near-misses, family concerns.

Personal and Family Medical History

The personal medical history review documents prior diagnoses, surgeries, hospitalizations, and significant medical events. The family medical history review documents conditions with genetic or familial components including cardiovascular disease, cancers (breast, colorectal, prostate, ovarian, lung), diabetes, dementia, and other conditions where family history modifies preventive screening recommendations.

Current Providers and Suppliers List

The providers and suppliers list documents the beneficiary's current healthcare team:

• Primary care physician
• Specialists (cardiology, nephrology, neurology, oncology, etc.)
• Dentist
• Optometrist or ophthalmologist
• Pharmacy
• Home health agency
• Durable medical equipment supplier
• Behavioral health provider
• Physical therapist, occupational therapist
• Other providers

The providers list supports care coordination and identifies gaps where additional services may be appropriate.

Current Medications and Supplements List

The medications list documents:

• Prescription medications (including dose, frequency, indication, prescriber)
• Over-the-counter medications
• Vitamins and supplements
• Herbal products
• Recreational substances if disclosed

The medications list supports medication review and reconciliation including identification of polypharmacy, potentially inappropriate medications in older adults (per Beers Criteria), drug-drug interactions, and adherence issues.

Review of Medical and Family History (Subsequent AWV Only)

Subsequent AWVs include a review of the beneficiary's medical and family history since the prior AWV, updating documentation with new diagnoses, procedures, hospitalizations, or significant family medical events.

Personalized Prevention Plan Service (PPPS)

The Personalized Prevention Plan Service synthesizes all the AWV's preceding components into a structured prevention plan with three core elements:

• Written schedule of recommended preventive services: a five- to ten-year schedule of recommended preventive services tailored to the beneficiary, including screenings, vaccinations, counseling services, and other preventive interventions.
• List of risk factors and conditions: identification of any risk factors and conditions for which interventions or referrals are appropriate, with documented referrals or interventions planned.
• List of treatment options: identification of treatment options for the beneficiary's existing conditions where additional treatment options should be considered.

The PPPS is documented in writing and provided to the beneficiary, with copies retained in the medical record and shared with other providers as appropriate.

The AWV as Gateway to Medicare Preventive Services

A central function of the AWV is to serve as the gateway and coordination point for the broader Medicare preventive services framework. Risk factors and conditions identified during the AWV trigger referrals to a comprehensive set of downstream preventive services:

Section 1861(ddd) Behavioral Counseling Services

• Alcohol misuse screening and counseling (NCD 210.8): AWV alcohol screening (AUDIT-C, SASQ) identifies beneficiaries for follow-up under G0442/G0443.
• Depression screening (NCD 210.9): AWV depression screening (PHQ-2/PHQ-9) identifies beneficiaries for follow-up under G0444 and treatment.
• IBT for cardiovascular disease (NCD 210.11): AWV cardiovascular risk factor assessment identifies beneficiaries for IBT for CVD under G0446.
• IBT for obesity (NCD 210.12): AWV BMI documentation identifies beneficiaries with BMI 30+ for IBT for obesity under G0447/G0473.
• STIs screening and HIBC (NCD 210.10): AWV sexual health assessment identifies beneficiaries for STI screening and HIBC under G0445.
• Tobacco cessation counseling (NCD 210.4.1): AWV tobacco use screening identifies beneficiaries for cessation counseling under CPT 99406/99407.

Section 1861(ddd) Screening Services

• Hepatitis C screening (NCD 210.13): AWV identifies eligibility for HCV screening under G0472.
• Hepatitis B screening (universal under IRA 2022 Section 11401): AWV identifies eligibility for HBV three-test panel under G0499.
• HIV screening (NCD 210.7): AWV identifies eligibility for HIV screening.

Medicare Diabetes Prevention Program (Section 1861(ddd) MDPP)

• AWV BMI documentation and diabetes risk assessment identify beneficiaries for MDPP eligibility evaluation. Beneficiaries with prediabetes and BMI 25+ (23+ Asian) are referred for MDPP under the once-per-lifetime benefit structure.

Medicare Diabetes Screening (Section 1861(yy))

• AWV diabetes risk assessment identifies beneficiaries for Medicare diabetes screening including A1C, FPG, or OGTT testing.

Medicare Cardiovascular Screening (Section 1861(xx))

• AWV cardiovascular risk assessment identifies beneficiaries for cardiovascular screening including lipid panel.

Medicare Glaucoma Screening (Section 1861(uu))

• AWV vision and eye health assessment identifies beneficiaries for glaucoma screening for high-risk populations (African American 50+, Hispanic 65+, diabetes, family history).

Cancer Screenings

• Colorectal cancer screening: AWV identifies eligibility for FIT, FOBT, sigmoidoscopy, colonoscopy, multi-target stool DNA.
• Mammography screening: AWV identifies eligibility for screening mammography.
• Cervical cancer screening: AWV identifies eligibility for Pap test and HPV screening.
• Prostate cancer screening: AWV identifies eligibility for PSA testing per USPSTF framework.
• Lung cancer screening (NCD 210.14): AWV tobacco use history identifies LDCT eligibility (age 50-77, 20+ pack-years, current smoker or quit within 15 years).

Bone Mass Measurement

• AWV osteoporosis risk assessment identifies eligibility for bone mass measurement under Section 1861(rr).

Abdominal Aortic Aneurysm Screening

• AWV identifies men age 65-75 who have smoked or who have family history for one-time AAA screening.

Cognitive Assessment and Care Plan (CPT 99483)

• AWV cognitive function detection identifies beneficiaries for follow-up Cognitive Assessment and Care Plan visit under CPT 99483.

The Annual Frequency Limit and IPPE Coordination

Annual Frequency Limit

The Annual Wellness Visit is available annually beginning twelve months after Medicare Part B enrollment. Beneficiaries who completed the IPPE within the first twelve months of Medicare enrollment are eligible for their first AWV beginning twelve months after the IPPE date (subject to the eleven-months-after-prior-AWV CMS billing guidance applied to AWV-AWV transitions). Beneficiaries who did not complete the IPPE are eligible for their first AWV beginning twelve months after Part B enrollment.

The annual frequency means once per twelve-month period. The CMS billing guidance allows the next AWV to be furnished beginning the first day of the eleventh month after the prior AWV (essentially eleven months) to provide some flexibility while preventing AWVs from drifting too close together.

IPPE Coordination

The Initial Preventive Physical Examination ("Welcome to Medicare") under Section 1861(ww) is a separate, once-in-a-lifetime visit available within the first twelve months of Medicare enrollment. The IPPE was added by the Medicare Modernization Act 2003 effective January 1, 2005 (preceding the AWV by six years).

The IPPE differs from the AWV in several ways. The IPPE is once-in-a-lifetime; the AWV is annual. The IPPE focuses on initial Medicare welcome including end-of-life planning discussion, certain initial screenings, and prevention planning specific to the Medicare transition. The AWV focuses on annual health risk assessment, ongoing prevention coordination, and longitudinal tracking. The IPPE and the AWV use different HCPCS codes (G0402 for IPPE, G0438/G0439 for AWV).

Beneficiaries who completed the IPPE are eligible for the AWV beginning twelve months after Medicare enrollment. Beneficiaries who did not complete the IPPE are eligible for the AWV beginning twelve months after Part B enrollment.

Eligible Providers for AWV

AWV may be furnished by:

• Physicians (MD or DO) including family medicine, internal medicine, geriatric medicine, and other specialties.
• Nurse practitioners (NPs) practicing in primary care or specialty roles.
• Physician assistants (PAs) practicing in primary care or specialty roles.
• Clinical nurse specialists (CNSs) practicing in primary care or specialty roles.
• Medical professionals (e.g., registered dietitians, health educators) working under the direct supervision of a physician for certain AWV components, with the physician retaining responsibility for the overall AWV.

AWV may be furnished in:

• Primary care office settings
• Multispecialty group practices
• Hospital outpatient departments
• Federally qualified health centers (FQHCs)
• Rural health clinics (RHCs)
• Other Medicare-enrolled provider settings

Telehealth AWV Delivery

Medicare telehealth coverage for the AWV expanded substantially during the COVID-19 public health emergency. CMS continued telehealth AWV in modified form following the PHE, with policy continuing to evolve. Current telehealth AWV delivery generally includes:

• Audio-video synchronous telehealth visits where the beneficiary uses a smartphone, tablet, or computer with video capability and Internet connection.
• Certain audio-only telehealth visits in defined circumstances (e.g., beneficiary lacks video capability).
• Provider's office or other originating site location flexibility.

Telehealth AWV is particularly important for rural Georgia counties where in-person AWV access may be constrained by primary care workforce shortages and travel distances. Telehealth AWV requires that the provider can adequately complete all required AWV components remotely, which may pose challenges for components requiring physical examination (height, weight, blood pressure) — these may be obtained through home measurement reported during the encounter, through a delegated in-person measurement at a clinic or pharmacy, or through prior measurements within an appropriate time window.

The Georgia AWV Landscape

Major Georgia Primary Care Programs

• Emory Healthcare: comprehensive academic primary care across metropolitan Atlanta with substantial AWV delivery integrated with downstream specialty referral.
• Wellstar Health System: large primary care network across north and northwest Georgia.
• Piedmont Healthcare: primary care network across central and north Georgia.
• Northside Hospital: primary care network primarily in metropolitan Atlanta.
• Augusta University Health: academic primary care in the Augusta region.
• Atrium Health Navicent: primary care in central Georgia (Macon and surrounding region).
• Memorial Health (HCA): primary care in southeast Georgia (Savannah and surrounding region).
• WellStar West Georgia: primary care in west Georgia.
• Phoebe Putney Health System: primary care in southwest Georgia (Albany region).

FQHC Network

Georgia's federally qualified health center network provides accessible primary care including AWV delivery on a sliding-fee basis. Major Georgia FQHCs include Mercy Care, Whitefoord, West End Medical, Albany Area Primary Health, Curtis V. Cooper Primary Health, Diversity Health Center, Four Corners Primary Care, and many others. For Medicare beneficiaries, AWV at FQHCs is covered under the same Section 1861(hhh) framework with zero cost-sharing under ACA Section 4104.

Rural Georgia Access

Rural Georgia counties — particularly in the southern and southwestern regions and parts of north Georgia — face primary care workforce shortages that affect AWV access. Critical access hospitals (CAHs) and rural health clinics (RHCs) provide primary care infrastructure in many rural counties. Telehealth AWV provides an important access pathway for rural beneficiaries.

Georgia Aging Population Context

Georgia's Medicare-eligible population has been growing steadily reflecting baby-boomer aging and continued in-migration. Atlanta metropolitan area Medicare population growth has been particularly substantial. Rural Georgia faces demographic pressures including aging-in-place patterns where older adults remain in counties with declining primary care infrastructure.

Best Practices for Georgia Medicare AWV

1. Schedule the AWV proactively. Beneficiaries should request AWV scheduling at the appropriate twelve-month interval rather than waiting for the primary care office to initiate. AWV is among the most-undertilized Medicare preventive services despite being free.

2. Complete the Health Risk Assessment thoroughly. The HRA is the primary data input for the personalized prevention plan. Beneficiaries should complete the HRA carefully and honestly, including topics that may feel uncomfortable (alcohol use, depression, sexual health, falls).

3. Bring complete medications list. Bring a current list of all prescription medications, over-the-counter medications, vitamins, and supplements. Many beneficiaries' medication lists are inaccurate or incomplete in the medical record.

4. Discuss cognitive concerns openly. Cognitive function detection is a required AWV component. Beneficiaries and family members should raise any cognitive concerns; identification of cognitive impairment enables earlier evaluation and intervention.

5. Address depression screening honestly. Depression in older adults is substantially underdiagnosed. The PHQ-2/PHQ-9 screening provides an opportunity to identify and treat depression that may otherwise go unaddressed.

6. Discuss advance care planning. The Advance Care Planning add-on (CPT 99497) provides a no-cost opportunity for advance care planning discussion during the AWV. Topics include health care decision-making preferences, advance directive completion, MOLST/POLST forms where applicable, and end-of-life preferences.

7. Review fall risk and home safety. Falls are a leading cause of injury and functional decline in older adults. The AWV functional ability assessment provides an opportunity to identify fall risk and intervene through home safety modifications, physical therapy referral, medication review, and other measures.

8. Use the personalized prevention plan as a roadmap. The PPPS provides a written five-to-ten-year schedule of recommended preventive services. Beneficiaries should retain the PPPS and use it to plan and track preventive service completion.

9. Coordinate downstream preventive services. AWV-identified risk factors should trigger appropriate referrals: alcohol screening positive → SBIRT counseling under NCD 210.8; depression screening positive → depression treatment; tobacco use → cessation counseling; BMI 30+ → IBT for obesity; prediabetes → MDPP; cardiovascular risk factors → IBT for CVD.

10. Maintain continuity of primary care. AWVs deliver greatest value when delivered by a primary care provider with longitudinal knowledge of the beneficiary. Continuity supports better risk assessment, more individualized prevention planning, and stronger coordination of downstream services.

11. Use telehealth AWV strategically. Telehealth AWV provides important access for rural beneficiaries and those with mobility limitations. In-person AWV may be preferable for beneficiaries needing physical examination, cognitive assessment in person, or care coordination conversations that benefit from in-person interaction.

12. Document family history thoroughly. Family history of cardiovascular disease, cancers, diabetes, and dementia substantially modifies preventive screening recommendations. Thorough family history documentation supports more individualized preventive care.

13. Plan for transitions. AWV provides an opportunity to plan for anticipated transitions: from independent living to assisted living, from driving to non-driving status, from full activity to functional limitation. Proactive planning supports better outcomes than reactive planning during crises.

14. Track AWV completion across years. Beneficiaries should track their AWV completion dates to ensure annual scheduling. The annual frequency is once per twelve-month period (with eleven-months-after-prior-AWV billing flexibility).

Common Issues and How to Resolve Them

1. Beneficiary confuses AWV with annual physical exam. Resolution: Explain that AWV is a preventive care visit covered at zero cost-sharing, not a comprehensive physical examination. Annual physical examinations covering existing conditions are billed separately and subject to standard Part B cost-sharing.

2. Beneficiary unaware AWV is free. Resolution: Educate that ACA Section 4104 waives cost-sharing for AWV. The visit should owe nothing out of pocket.

3. Cost-sharing applied to AWV. Resolution: Cost-sharing application to G0438 or G0439 is incorrect under ACA Section 4104. Contact the practice billing office and Medicare at 1-800-MEDICARE if not resolved.

4. AWV scheduled too soon after prior AWV. Resolution: AWV may be furnished no earlier than the first day of the eleventh month after the prior AWV per CMS billing guidance. AWV claims submitted earlier may be denied.

5. Beneficiary missed IPPE eligibility window. Resolution: IPPE is once-in-a-lifetime within the first twelve months of Medicare enrollment. Beneficiaries who missed the IPPE window are not eligible for IPPE but are still eligible for AWV beginning twelve months after Part B enrollment.

6. Required AWV component not addressed. Resolution: AWV documentation must reflect all required components. Inadequate documentation may result in claim denial. Beneficiaries can review the AWV summary and request follow-up if components appear to have been missed.

7. Beneficiary unwilling to discuss certain topics. Resolution: Sensitive topics (alcohol, depression, sexual health, falls, advance care planning) are required AWV components but can be addressed sensitively. Beneficiaries should understand that honest discussion supports better preventive care.

8. Cognitive function detection results in family conflict. Resolution: Cognitive impairment detection may surface family conflicts about driving, finances, or living arrangements. Primary care providers can facilitate sensitive conversations and refer to social work, geriatric medicine, or behavioral health as appropriate.

9. Telehealth AWV unable to capture required components. Resolution: Components requiring physical examination (height, weight, blood pressure) may be obtained through home measurement, delegated in-person measurement, or prior measurements within an appropriate time window. Cognitive function detection can be conducted via video.

10. Beneficiary in Medicare Advantage plan unsure of AWV coverage. Resolution: Medicare Advantage plans must cover AWV at the level of Original Medicare. Contact MA plan customer service for in-network providers.

11. Beneficiary with multiple chronic conditions and complex care. Resolution: AWV provides the framework for prevention planning even in beneficiaries with substantial chronic disease burden. The PPPS should reflect the beneficiary's specific situation and may emphasize different priorities than for relatively healthy beneficiaries.

12. AWV scheduled near other preventive services. Resolution: AWV can be coordinated with same-day preventive services (e.g., mammography, screening colonoscopy preparation discussion, vaccinations) where appropriate, improving efficiency for beneficiaries.

13. Beneficiary lacks transportation for AWV. Resolution: Telehealth AWV provides remote access. Transportation services through community resources, 211 Georgia, or Medicare Advantage supplemental benefits may also help.

14. Family member wants to attend AWV. Resolution: AWV often benefits from family member attendance particularly for beneficiaries with cognitive concerns. Family attendance can support history-taking, medication reconciliation, and care planning. Beneficiary consent is required.

Worked Examples

Example 1: Fulton County 65-Year-Old Newly Medicare-Eligible — Initial AWV G0438 Plus IPPE Coordination

A 65-year-old Fulton County beneficiary newly enrolled in Medicare attends her Initial Preventive Physical Examination at an Atlanta-area primary care practice within the first six months of Part B enrollment. Her IPPE includes the Welcome to Medicare components including end-of-life planning discussion, initial screenings, and prevention planning. The IPPE is billed under HCPCS G0402.

Twelve months after Part B enrollment (six months after the IPPE), she schedules her Initial AWV with the same primary care physician. The Initial AWV under HCPCS G0438 includes the full required components: Health Risk Assessment (covering tobacco/alcohol/physical activity/depression/social/functional), routine measurements (height 5'4", weight 165 lb, BMI 28.3, blood pressure 132/78), cognitive function detection (Mini-Cog 5/5, no concerns), depression screening (PHQ-2 0/6, PHQ-9 not indicated), functional ability and safety (independent ADLs, no fall history, home safety addressed), personal and family medical history (hypertension on diet, family history mother with breast cancer at 68, father with diabetes), current providers list (PCP, dentist, no specialists), medications (lisinopril 10 mg daily, calcium/vitamin D, multivitamin), and personalized prevention plan service.

The PPPS identifies and schedules: annual subsequent AWV next year, mammography screening (overdue by two years from prior history), Medicare diabetes screening given family history and elevated BMI, baseline DXA scan given age and gender, colorectal cancer screening status review, depression screening continued annually, alcohol screening continued annually, advance care planning discussion at next visit (or as ACP add-on today). The patient elects to add the Advance Care Planning add-on (CPT 99497) during the AWV — a thirty-minute discussion of advance directive completion, healthcare decision-making preferences, and MOLST consideration. All visits zero cost-sharing under ACA Section 4104.

Example 2: DeKalb County 70-Year-Old Subsequent AWV G0439 With Depression Screening Positive PHQ-2/PHQ-9

A 70-year-old DeKalb County beneficiary attends her Subsequent Annual Wellness Visit at her primary care physician's office. The AWV is billed under HCPCS G0439. During the depression screening component, her PHQ-2 returns 4/6 (positive) and the physician proceeds with the full PHQ-9, which returns 14/27 (moderate depression).

The PHQ-9 positive triggers further evaluation. The physician discusses the screening results, conducts a detailed depression interview ruling out medical contributors (thyroid function recently normal, medication review unremarkable for depressogenic effects, no substance use concerns), assesses safety (no suicidal ideation or intent), and identifies depression triggers including recent loss of spouse six months ago.

Treatment options discussion includes psychotherapy referral and pharmacotherapy options. The patient elects to begin both: a referral to a Medicare-enrolled licensed clinical social worker for weekly psychotherapy, and a trial of sertraline 25 mg daily titrated to 50 mg daily after one week. Follow-up scheduled in two weeks. The AWV depression screening coordinates with the Section 1861(ddd) depression screening framework under NCD 210.9, with the follow-up brief intervention counseling potentially billable under HCPCS G0444 if structurally separate from the AWV.

The Subsequent AWV is zero cost-sharing under ACA Section 4104. Subsequent depression treatment visits and psychotherapy are covered under standard Part B mental health benefits.

Example 3: Cobb County 68-Year-Old Subsequent AWV — Cognitive Function Detection Positive Mini-Cog Dementia Workup

A 68-year-old Cobb County beneficiary attends her Subsequent Annual Wellness Visit accompanied by her adult daughter. Her daughter expresses concerns that her mother has been increasingly forgetful, repeating questions, and getting lost while driving familiar routes.

During cognitive function detection, the physician administers the Mini-Cog. The patient recalls only one of three words after distraction and produces a substantially abnormal clock drawing. The Mini-Cog score is 1/5 (positive for cognitive impairment).

The physician proceeds with a structured cognitive workup including MoCA (returning 18/30 indicating moderate cognitive impairment), depression screening (negative ruling out pseudodementia from depression), medication review (no obvious cognitive contributors), and laboratory testing (TSH, vitamin B12, CBC, comprehensive metabolic panel). The physician refers to neurology for further evaluation and schedules a follow-up Cognitive Assessment and Care Plan visit under CPT 99483 to develop a structured dementia care plan including caregiver support and safety planning (driving cessation discussion, medication management, home safety).

The AWV is zero cost-sharing under ACA Section 4104. The Cognitive Assessment and Care Plan visit under CPT 99483 is covered under standard Part B with cost-sharing applied.

Example 4: Worth County 72-Year-Old Rural Subsequent AWV — Telehealth Delivery

A 72-year-old Worth County beneficiary in rural southwest Georgia has primary care through an Albany-based primary care practice. Travel from Worth County to Albany is approximately 30 miles each way, and the beneficiary increasingly finds the travel difficult.

The practice offers telehealth AWV. The beneficiary uses her smartphone with her daughter's assistance to connect for a video AWV. The visit includes:

• Health Risk Assessment (completed online prior to visit)
• Routine measurements (height/weight from home scale; blood pressure from home BP cuff measured during visit; BMI calculated)
• Cognitive function detection (Mini-Cog administered via video; 5/5)
• Depression screening (PHQ-2 0/6)
• Functional ability and safety (covered through discussion)
• Personal and family medical history review
• Current providers and medications list (verbal review)
• Personalized prevention plan service

The PPPS schedules: in-person follow-up for screening colonoscopy preparation discussion and Medicare diabetes screening, mammography arranged at a local Albany imaging center, annual subsequent AWV scheduled next year. All telehealth AWV components are zero cost-sharing under ACA Section 4104.

Example 5: Bibb County 75-Year-Old AWV With Advance Care Planning Add-On 99497

A 75-year-old Bibb County beneficiary attends her Subsequent Annual Wellness Visit at a Macon-area primary care practice. She has a recent diagnosis of stage III breast cancer currently undergoing chemotherapy, and her primary care physician wants to ensure her advance care planning is up to date.

The AWV components are completed under HCPCS G0439 including health risk assessment, measurements, cognitive function detection (normal), depression screening (mild), functional ability assessment, history review, medications review, and personalized prevention plan service.

Following the AWV components, the physician initiates the Advance Care Planning add-on (CPT 99497) for a thirty-minute structured discussion. Topics covered: healthcare decision-making preferences, advance directive completion (the patient has had an advance directive in place since age 70 but is updating it now), healthcare proxy designation (her daughter), code status preferences in event of cardiopulmonary arrest, palliative care goals, hospice care considerations should disease progress, organ donation preferences, and MOLST form completion given her serious illness.

The ACP add-on is documented separately from the AWV components. Both the AWV (G0439) and the ACP add-on (CPT 99497) when furnished during the AWV with modifier 33 are zero cost-sharing under ACA Section 4104.

Example 6: Hall County 80-Year-Old Subsequent AWV With Comprehensive Multi-Condition Coordination

An 80-year-old Hall County beneficiary attends his Subsequent Annual Wellness Visit with substantial chronic disease burden: type 2 diabetes, hypertension, atrial fibrillation on warfarin, COPD, mild cognitive impairment (MCI) diagnosis from prior workup, and recent fall with minor injury.

The Subsequent AWV under HCPCS G0439 addresses all required components:

• HRA documents complex health situation including limited physical activity, no current tobacco use (quit at 65), no alcohol use, mild depression symptoms emerging since wife's recent death.
• Measurements: BMI 24, BP 138/82 (elevated despite three antihypertensives), pulse irregular.
• Cognitive function detection: MoCA 22/30 (consistent with prior MCI diagnosis).
• Depression screening: PHQ-9 9/27 (mild range, new emergence concerning given recent loss).
• Functional ability: needs assistance with some IADLs (medications, shopping); ADLs largely independent; recent fall in past month.
• History review and medications review (comprehensive — 14 prescription medications, multiple supplements; flagged for polypharmacy review).
• Personalized prevention plan: pneumococcal vaccine update if due; influenza vaccine in coming weeks; fall prevention with PT referral; depression follow-up with consideration of psychotherapy referral; cognitive monitoring with annual reassessment; warfarin management coordination with cardiology; advance care planning update.

The complex AWV coordinates downstream services including PT referral for fall prevention, behavioral health referral for grief-related depression, polypharmacy review with pharmacy consult, cardiology follow-up for AFib management, and possible Section 1861(eee) cardiac rehabilitation evaluation. All AWV components zero cost-sharing under ACA Section 4104.

Frequently Asked Questions

Georgia Medicare AWV Contacts

• Medicare: 1-800-MEDICARE (1-800-633-4227) — general Medicare information and AWV coverage questions
• Palmetto GBA MAC: 1-866-238-9650 — Georgia Medicare Administrative Contractor for Part B claims
• DCH Medicaid Member Services: 1-866-211-0950 — Georgia Medicaid member services
• GeorgiaCares SHIP: 1-866-552-4464 — free Medicare counseling
• Medicare Rights Center: 1-800-333-4114 — free national Medicare counseling
• Atlanta Legal Aid: 404-377-0701 — legal services for Atlanta-area Medicare beneficiaries
• GA Legal Services: 1-800-498-9469 — legal services for Georgia outside Atlanta
• 211 Georgia: dial 211 — community resource referral
• Eldercare Locator: 1-800-677-1116 — national service connecting seniors with local services
• Georgia DPH: 404-657-2700 — Georgia Department of Public Health
• Alzheimer's Association GA: 1-800-272-3900 — dementia support, caregiver resources
• CDC-INFO: 1-800-232-4636 — federal CDC information
• Emory Healthcare — major Atlanta-area primary care for AWV
• Wellstar Health System — north Georgia primary care network
• Piedmont Healthcare — central and north Georgia primary care network
• Acentra Health QIO: 1-844-455-8708 — Georgia Quality Improvement Organization
• Medicare.gov — federal Medicare website
• Care Compare — Medicare provider finder at medicare.gov/care-compare