Physical Examination vs. Annual Wellness Visit: The Differences Explained

Can you tell the difference between an annual physical exam and an annual wellness visit (AWV)?

Question: Can you explain to me the difference between an annual physical visit and an annual wellness visit (AWV)?

Answers: While both types of exams have prevention in mind, there are many differences between them.

An annual physical exam is a more extensive exam than an annual Medicare spa visit. A typical annual check-up is a “practical” visit, including a physical exam and any blood work or laboratory tests that may be part of the check-up or required for the patient’s chronic stable problems.

Alternatively, the AWV is a hands-off risk assessment. The purpose of AWV is to identify gaps in care, improve a provider’s quality of care, and help build a picture of a patient’s current health status as a basis for future care.

What is included in a physical exam?

An annual physical exam is an assessment of your body’s health. The main purpose is to search for health problems.

During the exam, your doctor will use their senses – mainly vision, touch and hearing – to assess how your body is doing. Based on the findings, your doctor may ask you to undergo tests to detect or rule out possible health problems.

The list below shows some of the things a doctor may do during a physical exam.

Visually inspect the patient’s body as a whole for signs of existing health problems:

  • Conduct an examination of the patient’s eyes, ears, nose, and throat for possible problems
  • Listen to the patient’s heart and lungs to detect irregular sounds
  • Test motor skills and reflexes
  • Perform gynecological and rectal examinations
  • Measure height, weight and blood pressure

Submit or order urine and blood samples for laboratory testing, screening purposes and for ongoing chronic conditions

Typically, Medicare does not cover an annual physical exam. The exam and any tests your doctor orders are separate services, and depending on your Medicare plan, there may be associated costs.

What is included in a Medicare spa visit?

A Medicare AWV, also called a wellness assessment, is an assessment of the patient’s overall health and well-being. The primary purpose is prevention – either developing or updating the patient’s personalized prevention plan. Medicare provides an AWV every 12 months (must have passed 11 full months since your last visit), and patients are eligible for this benefit after receiving Part B for at least 12 months.

During the exam, a doctor or APP (usually a family doctor) combines information from the visit with the patient’s medical record to assess your risk for common preventable health conditions, such as heart disease, cancer, and type 2 diabetes. Based on the findings, your doctor creates your personal prevention plan with a checklist of the necessary preventive medical examinations.

The following list shows what should be done during a wellness assessment.

Review your health risk assessment (questions you answer about your health)

  • Confirm the patient’s medical and family history
  • Capture current medications (including prescription and over-the-counter medications) and providers
  • Measure and document the patient’s height, weight and blood pressure
  • Watch for signs of memory loss, dementia, frailty, depression, stress, pain and fatigue
  • Review behavioral risks, including tobacco use, physical activity, diet, oral health, alcohol use, sexual health, motor vehicles (e.g., use of seat belts), and home safety
  • Assess Activities of Daily Living (ADLs)
  • Document the patient’s health risk factors and treatment options, including referrals to education and counseling programs
  • Offer individual health advice
  • Develop a retirement plan (like a checklist) for the retirement benefits recommended for you
  • Review of Potential Risk Factors for Opioid Use Disorder (OUD)
  • Screening for potential substance use disorders (SUDs)
  • Advance care planning (e.g. living will, health power of attorney) if the patient so wishes

Medicare Part B covers one annual spa visit and many checkups with no co-payment or deductible. However, you may have to pay part of the cost of certain recommended tests or services.

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, based in Santa Barbara, California.

Leave a Comment