Closing the wellness visit gap.

Every practice knows the annual wellness visit is worth doing. Most complete it for a minority of the eligible panel anyway. The gap is almost never a clinical disagreement, and it is almost never fixed by trying harder.

Why the visit loses

It competes for an examination room with sick visits, and sick visits always win. The wellness visit takes the better part of half an hour to do properly, generates no urgent complaint to anchor it, produces no immediate patient demand, and is therefore the easiest thing on the schedule to defer to a quarter that never arrives.

Notice that none of those are motivation problems. They are scheduling and capacity problems, and they respond to structural fixes rather than to reminders.

Six things that actually move the rate

Take it out of the examination room. The single largest lever. For established patients the visit can be delivered by telephone under the telehealth flexibilities extended through 31 December 2027. A visit that does not need a room is no longer competing for one.

Measure the real baseline first. Pull the actual count of G0438 and G0439 claims from last year rather than estimating. Practices consistently guess high, and a programme that starts from a flattering baseline cannot show progress.

Work an eligibility list, not the whole panel. Sort by last visit date. Patients whose eligibility opens this month are a queue, not a mailing list, and the queue refreshes every month.

Say it costs nothing, early. The visit is covered at 100 percent with no coinsurance and no deductible. Patients decline because they assume a bill. Leading with the fact removes the most common objection before it is raised.

Attach the add-ons that belong. Advance care planning on the same day, and depression screening alongside a subsequent visit, are legitimately reportable and routinely left unbilled. Both have their own documentation requirements, so attach them when the work is genuinely done and not otherwise.

Use the visit to enrol. An annual wellness visit is a qualifying visit for care management. It is twenty unhurried minutes with a patient who is not sick, which is when chronic conditions surface honestly and consent can be explained properly. This is where the recurring revenue actually is.

Do the arithmetic before the programme

Multiply the number of additional completed visits by the blended rate, subtract the cost of whoever does them, and look at the remainder before committing. Our AWV revenue calculator will do it against your own panel and completion rate in about thirty seconds, and our visit worksheet is free if the problem is that the documentation takes too long.

If the remainder is small, do not run the programme. That is a legitimate outcome and it is better discovered now.

Questions people ask

Sources

• 42 CFR 410.15, annual wellness visit.
• CMS, Medicare Wellness Visits, MLN6775421.
• Medicare.gov, yearly wellness visits.
• CMS, Medicare telehealth.
• CMS, Physician Fee Schedule lookup.

Reviewed August 2026. Payment amounts are 2026 national averages adjusted by locality. Add-on codes carry their own coverage and documentation requirements. This is not billing or coding advice for your practice.