Annual Wellness Visits (AWV)

Annual Wellness Visit (AWV)

How to Fully Utilize the Annual Wellness Visit

Since being introduced, never has more than 15% of the Medicare population received the Annual Wellness Visit to which they are entitled. Why is this?

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Enter Oculus Health's Fully Integrated AWV Solution

Our unique offering is designed for delivering AWV and simplify delivery of integrated care plan. Our complimentary offering of CCM and TCM will accelerate your organizations' preparedness to deliver value-based care while generating significant new recurrent revenues.


Additionally, our care facilitation services extend your practices' reach and empower your patients to better take care of themselves. Every participant is supported by a dedicated, full-time health assistant for real-time feedback, support, and accountability.


AWV on the Telehealth List

AWVs have been on the telehealth list for several years, which reduces the hurdle to their utilization even further. Prior to the patient walking into the clinic, they can already have 95% of their AWV completed with only a handful of billing requirement tasks remaining. 

Imagine the PPPS in your and your patient's hand within minutes as opposed to an hour...

The Importance of Prioritizing AWVs

AWVs are the key to transitioning from the traditional reactive FFS care model to a proactive and preventive VBC model. Patients and Providers are able to assess the patient's current baseline of health, and get out ahead of identified risk areas. Intervention based on risk factors as opposed to waiting for symptoms to present themselves:

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During the AWV

During the AWV, physicians should take the following steps:

  1. Obtain the beneficiary’s information, including personal health data history through the administration of the Medicare HSA
  2. Assess the patient’s height, weight, vital signs, and other routine measurements deemed appropriate
  3. Provide personalized feedback and counseling on the assessment outcome and a personalized preventative care plan
  4. Update the HSA and other information annually for subsequent AWVs
Billing Medicare

Billing Medicare for an AWV requires physicians to submit a Personalized Prevention Plan for Services (PPPS) for patients.

Billing for AWV includes the following HCPCS codes:

  • G0438: Annual wellness visit; includes a PPPS, initial visit
  • G0439: Annual wellness visit: includes PPPS subsequent visit
PPPS creation

If the provider has the right business support solutions in place, the PPPS can easily be created for patients who already have a comprehensive plan of treatment in place.

Annual Wellness Visits Management Solution

During the AWV, providers are required to create and review the Patient’s Personalized Prevention Plan Service (PPPS). The AWV requires well-documented, individualized feedback. To effectively align the AWV, CCM, and preventative care services, providers will need fully integrated solutions that provide baseline reporting.

Oculus AWV Telehealth solutions include the following functionalities:

Integrated Electronic Health Risk Assessment

Electronic AWV Software Solution enables patients to complete nearly all of the HRA questionnaire prior to walking into the clinic, without having to repeat a single thing with the clinic staff or provider.

Turnkey solutions for AWV should provide physicians with the capacity to conduct Health Risk Assessments for data tracking, high-risk and CCM identification, and personalized feedback.

Many of the AWV measures tie directly to MIPS reporting quality measures. 

Automatic Personalized Prevention Plan Service (PPPS)

Providers should have the ability create in-depth, Personalized Prevention Plans to use during the patient consultation to identify and mitigate risk factors.

Telehealth AWV and preventative service functionalities should include the capacity to generate additional revenue by allowing providers to identify the need for preventative testing, order the testing, and track the results. Examples of preventative tests covered by Medicare include:

  • Bone density testing
  • Cancer screenings
  • Diabetes screenings
  • Flu shots

With an automatically generated PPPS, Providers can simply and succinctly identify all additional screenings, immunizations, counseling, and treatments that are appropriate for the patient.

Reporting Capabilities

Providers should be able to track patient risk factors, preventative care goals, along with quantitative and qualitative information for data extraction.

These will contribute to successful MIPS Quality Measures reporting. 

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See how our Telehealth AWV Solution works.


1. Oculus has the flexibility to seamlessly integrate with the practice and provider’s existing workflow.

2. During the initial onboarding period, we identify various touch points within the workflow.

3. Oculus is also able to automatically convert a patient’s EMR file to an electronic care plan for wellness, preventive, and Chronic Care Management.