Medicare Annual Wellness Visit Denied or Billed Wrong — How to Fix It

Medicare's Annual Wellness Visit (AWV) is one of its most valuable preventive benefits — and it's free to you at no cost. No copay. No deductible. Yet countless seniors receive unexpected bills after their wellness visit, or find that their claim was denied. In most cases, this is a billing or coding error — and you have the right to dispute it.

What Is the Medicare Annual Wellness Visit?

The Annual Wellness Visit is a Medicare Part B benefit that you're entitled to once every 12 months after you've been enrolled in Part B for more than 12 months. It is not a traditional physical exam. Instead, it's a structured health risk assessment and planning visit that includes:

• A review of your medical and family history
• Developing or updating a list of your current providers and medications
• Recording your height, weight, blood pressure, and other routine measurements
• A cognitive impairment assessment
• Personalized health advice and a referral to health education or preventive counseling
• A written screening schedule for appropriate preventive services

Importantly, the AWV is separate from a regular sick visit or comprehensive physical. It's covered as a preventive service at no cost to you.

The Confusion Between AWV and "Welcome to Medicare" Visit

If you're new to Medicare, you also have access to a separate benefit in your first 12 months: the "Welcome to Medicare" Preventive Visit. This is also free and involves a review of your health status, risk factors, and an education about Medicare preventive services.

The Welcome to Medicare visit is a one-time benefit; the AWV is an annual benefit you can use every year after that. These are two different services with different billing codes.

Why You Might Get a Bill After Your Annual Wellness Visit

The doctor addressed medical problems during the visit. This is the most common cause of unexpected charges. If your doctor discussed or treated a medical problem during your AWV — a new symptom, a chronic condition, a medication change — the doctor may bill separately for that portion of the visit. This results in a second claim that is not part of the free preventive service.

You can avoid this by scheduling a separate appointment for medical issues, or by being aware that if you bring up medical problems during the AWV, you may receive a bill for that portion. Your doctor should inform you of this upfront.

Billing error — wrong code used. The Annual Wellness Visit has specific billing codes (G0438 for the initial AWV, G0439 for subsequent AWVs). If your doctor's office accidentally billed using a general office visit code (such as an Evaluation and Management code like 99213 or 99214) instead of the correct AWV code, Medicare may process it as a regular visit with cost-sharing rather than a free preventive service.

Too soon since last AWV. Medicare covers the AWV once every 12 months. If you had a visit less than 12 months ago, a second visit will be denied.

Physician not enrolled in Medicare. If your doctor doesn't accept Medicare or isn't enrolled, the free coverage doesn't apply. Always confirm your provider accepts Medicare before scheduling.

Mixed up with physical exam billing. Some doctors bill an AWV alongside a traditional physical exam. Medicare doesn't cover routine physical exams (they're not a standard Medicare benefit), so that portion of the billing would not be covered, and you'd be responsible for it.

How to Dispute an Incorrect AWV Bill

Step 1: Get an EOB)" class="auto-link">Explanation of Benefits (EOB). Review your Medicare Summary Notice (MSN) or your Medicare Advantage plan's EOB. Look at the procedure code used. If it shows a standard office visit code rather than G0438 or G0439, you likely have a billing error.

Step 2: Contact your doctor's office. Ask the billing department to review and correct the billing code if the visit was indeed an Annual Wellness Visit without separate medical services. A corrected claim resubmitted with the correct code should resolve the issue.

Step 3: Contact Medicare. If the billing department doesn't resolve it, call 1-800-MEDICARE. Explain that you received a bill for a service that should be free under the Medicare Annual Wellness Visit benefit. Medicare can investigate billing issues.

Step 4: File a formal appeal. If the charge isn't corrected and you've received a formal denial, you can file a Redetermination appeal with the Medicare Administrative Contractor. Submit documentation showing the visit was intended as an AWV and provide the correct billing information.

Preventive Services Billed During the AWV

Your doctor may order additional preventive services as part of your AWV — blood pressure screening, diabetes screening, depression screening, or others. Many of these are also free under Medicare's preventive benefits when ordered at the appropriate frequency. If you're billed for tests ordered during your AWV, check whether they fall under covered preventive screenings.

Keeping Track of Your AWV

Mark your calendar each year to schedule your Annual Wellness Visit. Remember:

• Must be more than 12 months since your last AWV
• The visit must be with a Medicare-enrolled provider
• The visit should focus on prevention and planning — keep medical concerns for a separate appointment or understand that you may be billed for that portion

Fight Back With ClaimBack

If you've received an unexpected bill for your Medicare Annual Wellness Visit or a claim was denied, you don't have to accept it. ClaimBack helps you identify the billing issue and build the documentation needed to dispute it effectively.

Start your appeal at ClaimBack

Related Reading

• Medicare Denied Preventive Screening — Colonoscopy, Mammogram, PSA Appeals
• How to Write an Insurance Appeal Letter
• Common Reasons Insurance Claims Are Denied