Annual Wellness Visit vs. Office Visit: How to Help Patients Understand the Difference

It’s one of the most common misunderstandings in outpatient care. A patient schedules what they believe is a free checkup, but after the appointment, they receive a bill. Now, your front office staff is fielding questions, and your billing team is reviewing documentation to figure out what happened.

The confusion between Annual Wellness Visits (AWV) and Regular Office Visits creates headaches for patients, providers, and revenue cycle teams, too. But with clear communication, thoughtful documentation, and a few proactive tools, your team can set expectations and avoid unnecessary back-and-forth. 

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What Is an Annual Wellness Visit?

An annual wellness visit focuses on prevention. It’s covered by Medicare and most commercial insurance plans with no-cost sharing, as long as the visit stays within specific parameters.

Services typically include:

• Cancer screenings (breast, cervical, colorectal, prostate)
• Screenings for diabetes, depression, HIV, and other conditions 
• Immunizations
• Tobacco use counseling
• Risk assessments and prevention planning

These visits are not meant to address new health concerns or manage existing conditions. If a patient wants to talk about symptoms or refill a prescription, that care falls outside the scope of a yearly wellness visit.

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What Is a Regular Office Visit?

A regular office visit focuses on evaluation and management. This is where patients bring up a new issue, follow up on a chronic condition, or request adjustments to their medication. These visits are typically subject to a copay or deductible.

Many patients believe that a wellness visit and a checkup are the same. For payers, they are very different and that difference matters when it comes to coverage and coding.

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Why It Matters for Your Practice

The mix-up between visit types can lead to a number of issues. Patients may leave thinking the visit was covered in full, only to receive a bill later. Staff may have to explain coverage details after the fact, and billing teams may face claim denials or rework.

This is especially frustrating when it could have been avoided. A clear explanation before the visit helps ensure patients know what to expect and can help your team avoid unnecessary appeals or write-offs.

This topic also connects to larger trends in patient balance management. Helping people understand what they’re being charged for builds trust and supports more consistent collections.

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Can You Bill for Both? Yes, But Only With Clear Documentation

In some cases, it’s appropriate to provide both an annual wellness visit and regular office visit during the same appointment. For example, a patient may complete their preventative screenings but also bring up a separate issue like back pain or fatigue.

Here’s how to bill for both:

• Use modifier 25 on the E/M code to show that the office visit was separate from the wellness check
• Document each service individually, with distinct notes that show the provider performed both types of care
• Avoid vague charting that could lead to denials or require additional clarification
• Train staff to flag these appointments so billing teams know to review them closely

Make sure the medical necessity for the additional visit is well-supported and clearly written. Strong documentation protects your revenue cycle and keeps you in good standing with payers. 

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Helping Patients Understand the Difference

The best time to set expectations is before the patient walks through the door. That means your front desk team plays a major role in ensuring a smooth and clean claim.

Here are a few practical ways to make that happen:

• Mention coverage and visit types when scheduling appointments
• Offer a simple explanation in the confirmation call or message
• Use consistent language, such as:

“Your wellness visit will focus on preventative care, including screenings and immunizations. If you have other concerns you’d like to discuss, your insurance may treat that as a separate visit, and it may require a copay or deductible.”

• Provide a one-page checklist that outlines what’s covered under a wellness visit and what’s not.

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Make It Easier With a Patient-Friendly Checklist

Even with consistent communication, some patients need a visual aid to fully understand what’s included in their appointment (and what’s not). A simple easy-to-use checklist can go a long way in setting expectations before they arrive.

We’ve created one you can hand out at the front desk or send through your patient portal. It outlines which services are covered under an Annual Wellness Visit, which ones are not, and what that means for their insurance.

It also encourages patients to jot down any additional concerns and helps them decide whether those topics should be addressed in a separate visit.

This tool can save your team time, reduce follow-up calls, and make the billing process smoother for everyone.

Get the Checklist here.

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Final Thoughts 

Confusion about visit types doesn’t just lead to awkward billing conversations. It can slow down your revenue cycle, frustrate your staff, and negatively impact patient satisfaction.

Clear communication is key. When your team can confidently explain the difference between a wellness visit and a problem-based visit, patients are more likely to trust the process and less likely to dispute their bill.

Supporting your staff with tools like checklists, consistent messaging, and billing guidance can make a real difference.