Medicare Wellness Visits (MWVs) improve patient outcomes, enhance care quality, and reduce healthcare costs. These free visits for Medicare beneficiaries, which may be conducted via Telehealth, are focused on preventive plans. During these appointments, providers identify risk factors and applicable intervention recommendations in a less acute, illness-focused visit. AWVs also grant the opportunity to capture or address quality measures specific to value-based contracts.
In 2025, Medicare has introduced several enhancements to the Annual Wellness Visits to improve preventive care and address beneficiaries’ comprehensive health needs. Here’s an overview of what you need to know about these changes to Medicare Wellness Visits:
Changes to the Basics – New Requirements
- IPPE
- Includes add-on code when included with another type of office visit – “Starting in 2025, Medicare pays for the office/outpatient (O/O) evaluation and management (E/M) visit complexity add-on code G2211 when the O/O E/M base code is reported by the same practitioner on the same day as an AWV, vaccine administration, or any Part B Preventive Service, including the IPPE, provided in the office or outpatient setting.”
- AWVs
- Includes add-on code when included with another type of office visit
- SDOH Risk Assessment optional with consent – only time patient has no co-pay for SDOH. May be conducted via Telehealth.
Changes to Screening & Preventive Services
- Alcohol Misuse Screening & Counseling
- Verbiage change to frequency for G0443 (counseling, interventions) allowed per year and per visit.
- Colorectal Cancer Screening
- New covered service/code – CPT 74263 (CT Colonography, screening, including image post processing)
- Frequencies for low and high-risk changes
- COVID-19 Vaccine and Administration
- Rate for this vaccine is different than other Part B preventive vaccines
- Depression Screening
- Screening may be delivered in primary care setting or via Telehealth with staff-assisted depression care support in place to ensure accurate diagnosis, effective treatment, and follow-up.
- POS Code 10 – Telehealth services provided when patient is home
- POS Code 02 – Patient is somewhere other than their home
- Screening may be delivered in primary care setting or via Telehealth with staff-assisted depression care support in place to ensure accurate diagnosis, effective treatment, and follow-up.
- Diabetes Screening
- Hemoglobin A1c with CPT Code 86036 is eligible Blood Glucose Test
- Added 2 screenings within 12-month period following date of patient’s most recent diabetes screening
- Diabetes Self-Management Training (DSMT)
- Initial 10 hours of training or annual 2 hours of DSMT for insulin-dependent through telehealth may be used when clinically appropriate
- New billing advice for DSMT and Medical Nutrition Therapy
- Hepatitis B (HepB) Vaccine and Administration
- Physician’s order is no longer required for administration
- Eligibility now includes patients who have not received a completed HepB vaccine series or whose vaccination history is unknown
- HIV PrEP using Antiretroviral Therapy
- New covered service
- Multiple new ICD-10 codes for components of the PrEP process: medication type, supply code (pharmacy), counseling, administration
- Grade A USPSTF reccomendation
- Influenza Virus Vaccine and Administration
- New HCPCS codes for 2024-2025
- IPPE
- New code verbiage for add-on complexity code
- Pneumococcal Vaccine and Administration
- Age lowered for administration to 50 years of age
- New HCPCS for vaccine types
- Prolonged Preventive Services
- New information on “substantive portion” of visit and how it is related to prolonged preventive service
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services for Substance Use
- Updated coding per type of intervention
- Additional provider codes added for Marriage and Family Therapists and Mental Health Counselors providing SBIRT services
- STI Screening & High Intensity Behavioral Counseling (HIBC)
- Removed HepB screening service, as it is a separate covered service
These updates to Annual Wellness Visits aim to provide a more holistic approach to preventive care, addressing both medical and social factors that influence health outcomes.
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