Study guide
67.5 The Periodic Adult Health Examination & Medicare Annual Wellness Visit
ABFM Family Medicine Certification Study Guide Exam
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1 Chapter 1: Exam Structure, Blueprint & Clinical Decision-Making
1.1 Exam Blueprint, FMCLA vs. One-Day Exam & Board Scoring 1.2 Clinical Reasoning, Test-Taking Strategy & Ambiguity Management 1.3 Evidence-Based Medicine & Clinical Practice Guidelines in Primary Care
2 Chapter 2: Healthcare Systems, Practice Management & Quality
2.1 Practice Management, Billing, Coding & Documentation 2.2 Quality Improvement, Patient Safety & Diagnostic Stewardship 2.3 Interprofessional Team-Based Care & Care Coordination
3 Chapter 3: Ethics, Law, Biostatistics & Health Equity
3.1 Medical Ethics, Informed Consent & Surrogate Decision-Making 3.2 Biostatistics, Clinical Epidemiology & Diagnostic Test Interpretation 3.3 Social Determinants of Health, Health Equity & Cultural Humility 3.4 Physician Wellness, Burnout Prevention & Professionalism
4 Chapter 4: Lifestyle Counseling & Behavior Change
4.1 Alcohol Use Screening & Brief Intervention 4.2 Illicit Drug & Cannabis Counseling 4.3 Tobacco & Vaping Cessation Counseling
5 Chapter 5: Nutrition, Physical Activity & Chronic Disease Prevention
5.1 Dietary Counseling for Obesity & Chronic Disease Prevention 5.2 Exercise Prescription & Physical Activity Counseling 5.3 Genetic Risk Assessment & Family History Counseling
6 Chapter 6: Routine Adult Immunizations
6.1 ACIP Adult Respiratory Vaccines: Influenza, COVID-19, RSV & Pneumococcal 6.2 ACIP Adult Non-Respiratory Vaccines: Tdap, Shingrix, HPV & Hep B 6.3 Immunizations in Special Populations: Pregnancy, Asplenia & Immunocompromise
7 Chapter 7: Pediatric Health Maintenance & Surveillance
7.1 Newborn Examination & Early Postnatal Care 7.2 Well-Child Care, Developmental Surveillance & Milestones 7.3 Pediatric & Adolescent Screening: Vision, Hearing, Anemia & Lead 7.4 Pediatric Oral Health, Dental Screening & Fluoride
8 Chapter 8: Behavioral Health & Safety Screening
8.1 Primary Care Depression, Anxiety & Behavioral Health Screening 8.2 Domestic Violence, Intimate Partner Violence & Firearm Safety 8.3 Occupational Health & Recreational Safety Counseling
9 Chapter 9: Adult Preventive Screening: Cardiovascular & Metabolic
9.1 Cardiovascular Disease & Hypertension Screening 9.2 Type 2 Diabetes Screening & Prediabetes Risk Stratification 9.3 Abdominal Aortic Aneurysm & Osteoporosis Screening
10 Chapter 10: Adult Cancer Screening: Breast & Gynecologic
10.1 Breast Cancer Screening & Risk-Assessment 10.2 Cervical Cancer Screening & ASCCP Algorithms 10.3 Skin Cancer Clinical Assessment & Counseling
11 Chapter 11: Adult Cancer Screening: Colorectal, Lung & Prostate
11.1 Colorectal Cancer Screening Modalities & Intervals 11.2 Lung Cancer Screening with Low-Dose CT 11.3 Prostate Cancer Screening & Shared Decision-Making
12 Chapter 12: Sexual Health, Infectious Disease Screening & Contraception
12.1 Sexual Health Counseling & Risk-Reduction Strategies 12.2 STI Screening: Chlamydia, Gonorrhea, Syphilis & Trichomoniasis 12.3 Bloodborne Infectious Disease Screening: HIV & Hepatitis C
13 Chapter 13: Reproductive Life Planning, Lactation & Preoperative Care
13.1 Preconception Planning & Comprehensive Contraception Management 13.2 Lactation Support & Breastfeeding Counseling 13.3 Preoperative Medical Evaluation & Pre-Participation Sports Exam
14 Chapter 14: Emergent Cardiovascular Conditions
14.1 Acute Coronary Syndromes & Myocardial Infarction 14.2 Acute Chest Pain Risk Stratification & Triage 14.3 Acute or Critical Valvular Heart Emergencies
15 Chapter 15: Cardiac Arrhythmias, Heart Failure & Hypertensive Crises
15.1 Acute Atrial & Ventricular Arrhythmias 15.2 Acute Decompensated Heart Failure & Cardiogenic Shock 15.3 Hypertensive Emergency & Urgency Management
16 Chapter 16: Vascular & Thromboembolic Emergencies
16.1 Pulmonary Embolism & Deep Vein Thrombosis 16.2 Acute Aortic Syndromes & Peripheral Vascular Emergencies 16.3 Critical Limb Ischemia & Acute Arterial Occlusion
17 Chapter 17: Neurologic Emergencies: Stroke & Altered Consciousness
17.1 Acute Ischemic Stroke & Intracranial Hemorrhage 17.2 Syncope Evaluation & Status Epilepticus 17.3 Acute Delirium, Encephalopathy & Severe Confusion
18 Chapter 18: Neurologic Trauma & Acute Cranial Emergencies
18.1 Concussion, Moderate-to-Severe TBI & Intracranial Injury 18.2 Thunderclap & Acute Severe Secondary Headaches 18.3 Acute Ophthalmologic Emergencies
19 Chapter 19: Acute Abdominal, Pelvic & Gastrointestinal Emergencies
19.1 Acute Abdominal & Pelvic Pain Triage 19.2 Upper & Lower Gastrointestinal Bleeding 19.3 Acute Hepatic Failure, Cholangitis & Severe Jaundice
20 Chapter 20: Acute Pulmonary & Airway Emergencies
20.1 Acute Hypoxic Respiratory Failure & ARDS 20.2 Severe Community-Acquired Pneumonia & Empyema 20.3 Acute Severe Epistaxis & Airway Obstruction
21 Chapter 21: Acute Traumatic Injuries & Wound Care
21.1 Major Trauma Resuscitation & Initial Assessment 21.2 Burn Assessment, Inhalation Injury & Resuscitation 21.3 Laceration Management, Complex Wounds & Animal Bites
22 Chapter 22: Acute Orthopedic & Musculoskeletal Emergencies
22.1 Acute Ambulatory Fractures & Initial Splinting 22.2 Compartment Syndrome & Major Orthopedic Trauma 22.3 Septic Arthritis & Acute Microcrystalline Crises
23 Chapter 23: Severe Infections, Sepsis & Systemic Emergencies
23.1 Sepsis, Septic Shock & Initial Fluid Resuscitation 23.2 Necrotizing Soft Tissue Infections & Severe CNS Infections 23.3 Anaphylaxis Diagnosis, Epinephrine Dosing & Airway Protection
24 Chapter 24: Metabolic, Endocrine & Electrolyte Emergencies
24.1 Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State 24.2 Critical Electrolyte Emergencies: Dyskalemias & Dysnatremias 24.3 Severe Calcium Abnormalities & Acute Adrenal Crisis
25 Chapter 25: Hematologic, Urologic & Dental Emergencies
25.1 Severe Symptomatic Anemias & Coagulopathic Emergencies 25.2 Testicular Torsion, Priapism & Acute Urinary Retention 25.3 Urgent Odontogenic Infections & Dental Trauma
26 Chapter 26: Psychiatric, Behavioral & Obstetric/Gynecologic Emergencies
26.1 Suicidal Ideation, Acute Agitation & Behavioral Emergencies 26.2 Acute Physical & Sexual Assault Care 26.3 Life-Threatening Vaginal Bleeding & Ectopic Pregnancy 26.4 Environmental Heat Stroke & Severe Hypothermia
27 Chapter 27: Acute Head, Neck & Neurologic Symptoms
27.1 Primary Acute Headaches: Migraine, Tension & Cluster 27.2 Concussion & Minor Closed Head Injury Evaluation 27.3 Transient Ischemic Attack Evaluation & ABCD2 Risk Scoring
28 Chapter 28: Acute Cranial Nerves, Hearing & Sensory Symptoms
28.1 Peripheral Neuropathies: Bell's Palsy, Carpal Tunnel & Radiculopathy 28.2 Acute Tinnitus, Sudden Sensorineural Hearing Loss & Cerumen Impaction 28.3 Acute Dizziness, Benign Paroxysmal Positional Vertigo & Vestibular Neuritis
29 Chapter 29: Acute Upper Respiratory Tract Infections
29.1 Acute Viral Rhinosinusitis vs. Bacterial Rhinosinusitis 29.2 Acute Pharyngitis: Group A Streptococcus & Centor Criteria 29.3 Acute Otitis Media, Otitis Externa & Serous Effusion
30 Chapter 30: Acute Lower Respiratory Infections & Cough
30.1 Influenza, COVID-19 & Viral Respiratory Syndromes 30.2 Acute Bronchitis & Lower Respiratory Tract Infections 30.3 Ambulatory Community-Acquired Pneumonia
31 Chapter 31: Allergic, Nasal & Non-Infectious Pulmonary Conditions
31.1 Allergic Rhinitis & Acute Non-Anaphylactic Allergic Reactions 31.2 Acute Dyspnea in Ambulatory Care 31.3 Interstitial Lung Diseases & Sarcoidosis Presentation
32 Chapter 32: Acute Chest, Cardiac & Vascular Symptoms
32.1 Palpitations Evaluation & Arrhythmia Triage in Primary Care 32.2 Deep Vein Thrombosis & Superficial Thrombophlebitis 32.3 Ambulatory Hypotension & Orthostasis Evaluation
33 Chapter 33: Acute Upper Gastrointestinal Conditions
33.1 Peptic Ulcer Disease & Gastritis 33.2 Dysphagia, Esophagitis & Acute Esophageal Disorders 33.3 Acute Nausea, Vomiting & Foodborne Illness
34 Chapter 34: Acute Lower Gastrointestinal Conditions
34.1 Acute Infectious Diarrhea & Gastroenteritis 34.2 Acute Constipation & Functional Bowel Changes 34.3 Ano-Rectal Disorders: Hemorrhoids, Fissures, Abscesses & Pruritus Ani
35 Chapter 35: Inflammatory, Functional & Malabsorptive GI Disorders
35.1 Acute Flares of Inflammatory Bowel Disease 35.2 Irritable Bowel Syndrome: Diagnosis, Subtyping & Management 35.3 Celiac Disease & Malabsorption Syndromes
36 Chapter 36: Acute Abdominal, Hepatic & Biliary Disorders
36.1 Ambulatory Abdominal & Pelvic Pain Triage 36.2 Acute Cholecystitis, Biliary Colic & Pancreatitis 36.3 Acute Liver Injury & Viral Hepatitis
37 Chapter 37: Acute Abdominal Wall, Hernias & Dental Conditions
37.1 Abdominal Wall, Inguinal & Ventral Hernias 37.2 Acute Dental Pain, Odontogenic Abscess & Aphthous Ulcers 37.3 Acute Edema: Unilateral vs. Bilateral Diagnostic Evaluation
38 Chapter 38: Acute Infectious Dermatoses
38.1 Bacterial Skin Infections: Impetigo, Cellulitis & Cutaneous Abscesses 38.2 Fungal Skin Infections: Tinea Corporis, Cruris, Pedis & Onychomycosis 38.3 Viral Cutaneous Infections: Herpes Simplex, Zoster & Molluscum Contagiosum
39 Chapter 39: Inflammatory, Allergic & Autoimmune Dermatoses
39.1 Atopic Dermatitis, Contact Dermatitis & Eczematous Flares 39.2 Non-Infectious Rashes: Urticaria, Drug Eruptions & Erythema Multiforme 39.3 Cutaneous Malignancies & Premalignant Lesions: AK, BCC, SCC & Melanoma
40 Chapter 40: Acute Shoulder, Elbow & Upper Extremity Injuries
40.1 Rotator Cuff Pathology, Tendinopathy & Shoulder Impingement 40.2 Lateral & Medial Epicondylitis, Olecranon Bursitis & Elbow Sprains 40.3 Wrist & Hand Soft-Tissue Injuries: De Quervain, TFCC & Finger Sprains
41 Chapter 41: Acute Knee, Ankle & Lower Extremity Injuries
41.1 Meniscal Tears, Ligamentous Knee Injuries & Patellofemoral Pain 41.2 Ankle Sprains, Ottawa Ankle Rules & Achilles Tendinopathy 41.3 Plantar Fasciitis, Shin Splints & Overuse Syndromes
42 Chapter 42: Acute Ambulatory Fractures & Dislocations
42.1 Distal Radius, Scaphoid & Common Upper Extremity Fractures 42.2 Metatarsal, Clavicle & Common Lower Extremity Fractures 42.3 Joint Dislocation Management: Nursemaid's Elbow & Shoulder Subluxation
43 Chapter 43: Acute Axial Musculoskeletal Pain & Falls
43.1 Acute Low Back Pain: Red Flags, Strain & Disc Herniation 43.2 Acute Cervical Strain, Whiplash & Axial Neck Pain 43.3 Evaluation of Falls in Ambulatory & Older Patients
44 Chapter 44: Acute Inflammatory Arthropathies & Generalized Pain
44.1 Acute Inflammatory Arthritis & Spondyloarthropathies 44.2 Myalgias, Rhabdomyolysis & Post-Viral Pain Syndromes 44.3 Acute Non-Headache Pain Management Strategies
45 Chapter 45: Acute Renal, Urinary & Genitourinary Conditions
45.1 Uncomplicated UTI, Pyelonephritis & Acute Urethritis 45.2 Hematuria Workup & Glomerulonephritis 45.3 Nephrolithiasis & Acute Urinary Tract Obstruction
46 Chapter 46: Acute Male Genitourinary & Prostatic Conditions
46.1 Acute Prostatitis, Epididymitis & Orchitis 46.2 Acute Scrotal Pain: Torsion vs Appendage, BPH & Male Genital Emergencies 46.3 Acute Urinary Retention & Incontinence Evaluation
47 Chapter 47: Acute Women's Health & Early Pregnancy Care
47.1 Early Pregnancy Diagnosis, Dating & Initial Complications 47.2 Abnormal Uterine Bleeding & Acute Menstrual Disorders 47.3 Premenstrual Syndrome & Premenstrual Dysphoric Disorder
48 Chapter 48: Breast Disorders, STIs & Pediatric Elimination
48.1 Palpable Breast Mass, Mastitis & Nipple Discharge 48.2 Sexually Transmitted Infections: Diagnosis, Staging & CDC Guidelines 48.3 Pediatric Enuresis & Encopresis
49 Chapter 49: Systemic Signs, Metabolic Dysregulation & Miscellaneous Infections
49.1 Acute Fever, Sepsis Screening & FUO in Primary Care 49.2 Acute Hyperglycemia & Symptomatic Hypoglycemia 49.3 Electrolyte Abnormalities: Mild-to-Moderate Disturbances 49.4 Vector-Borne, Tick-Borne & Rickettsial Illnesses
50 Chapter 50: Chronic Cardiovascular Diseases: Hypertension & Ischemia
50.1 Essential Hypertension Management: 2025 AHA/ACC Guideline & JNC Strategies 50.2 Chronic Coronary Artery Disease & Post-MI Secondary Prevention 50.3 Chronic Heart Failure: HFrEF, HFpEF & Quadruple GDMT
51 Chapter 51: Chronic Vascular, Valvular & Dyslipidemic Diseases
51.1 Peripheral Arterial Disease & Claudication 51.2 Chronic Valvular Heart Disease & Murmur Evaluation 51.3 Lipid Disorders & ASCVD Risk-Based Statin Therapy
52 Chapter 52: Chronic Respiratory Diseases: Asthma & COPD
52.1 Chronic Asthma Management: GINA Stepwise SMART Therapy 52.2 Chronic Obstructive Pulmonary Disease: GOLD Recommendations 52.3 Solitary Pulmonary Nodule Evaluation & Fleischner Society Criteria
53 Chapter 53: Chronic Metabolic Diseases: Diabetes Mellitus
53.1 Type 2 Diabetes Management: ADA Pharmacotherapy Algorithms 53.2 Type 1 Diabetes: Basal-Bolus Insulin, CGMs & Diabetic Complications 53.3 Diabetic Microvascular & Macrovascular Disease Surveillance
54 Chapter 54: Obesity, Nutrition & Metabolic Bone Diseases
54.1 Medical & Behavioral Management of Obesity & Incretin Mimetics 54.2 Osteoporosis & Metabolic Bone Disease: DEXA, FRAX & Antiresorptives 54.3 Nutritional Deficiencies: Vitamin D, B12, Iron & Malnutrition
55 Chapter 55: Chronic Endocrine Disorders
55.1 Primary & Subclinical Hypothyroidism, Hyperthyroidism & Nodules 55.2 Adrenal Disorders: Addison's Disease & Cushing's Syndrome 55.3 Hypercalcemia, Hyperparathyroidism & Pituitary Disorders
56 Chapter 56: Chronic Kidney Disease & Venous Disorders
56.1 Chronic Kidney Disease: KDIGO Staging & Renoprotective Therapy 56.2 Chronic Venous Insufficiency, Stasis Dermatitis & Lymphedema 56.3 Chronic Electrolyte & Acid-Base Management in CKD
57 Chapter 57: Chronic Gastrointestinal & Hepatic Diseases
57.1 Gastroesophageal Reflux Disease, Barrett's Esophagus & Dyspepsia 57.2 Chronic Liver Disease: MASLD/NAFLD, Cirrhosis & Portal Hypertension 57.3 Viral Hepatitis B & C: Long-Term Monitoring & DAA Therapy
58 Chapter 58: Colorectal Surveillance & Chronic Pancreaticobiliary Care
58.1 Post-Polypectomy Colorectal Polyp Surveillance Guidelines 58.2 Chronic Pancreatitis & Exocrine Pancreatic Insufficiency 58.3 Chronic Nausea, Gastroparesis & Functional GI Disorders
59 Chapter 59: Chronic Musculoskeletal & Rheumatologic Disorders
59.1 Osteoarthritis: Hip, Knee & Hand Management 59.2 Spinal Conditions: Spinal Stenosis, Spondylolisthesis & Compression Fractures 59.3 Chronic Myopathies & Fibromyalgia Syndrome
60 Chapter 60: Chronic Neurologic & Neurodegenerative Disorders
60.1 Dementia: Alzheimer's, Vascular & Lewy Body Disease 60.2 Parkinson's Disease & Essential Tremor 60.3 Epilepsy: Chronic Antiseizure Medications & Post-Stroke Care
61 Chapter 61: Chronic Peripheral Nerves, Pain & Sensory Disorders
61.1 Diabetic & Chronic Peripheral Neuropathies 61.2 Chronic Pain Syndromes & Chronic Daily Headaches 61.3 Chronic Tinnitus, Presbycusis & Persistent Dizziness
62 Chapter 62: Chronic Psychiatric Disorders
62.1 Major Depressive Disorder & Generalized Anxiety Disorder 62.2 Bipolar Disorder: Maintenance Pharmacotherapy & Lithium Monitoring 62.3 Adult & Pediatric Attention-Deficit/Hyperactivity Disorder
63 Chapter 63: Chronic Behavioral Health & Neurodevelopmental Conditions
63.1 Chronic Behavioral Conditions: PTSD, OCD & Somatization 63.2 Autism Spectrum Disorder & Intellectual Disabilities 63.3 Eating Disorders: Anorexia Nervosa, Bulimia & Binge Eating
64 Chapter 64: Chronic Substance Use Disorders & Tobacco Cessation
64.1 Alcohol Use Disorder: Pharmacotherapy & Relapse Prevention 64.2 Opioid & Stimulant Use Disorders: MOUD & Harm Reduction 64.3 Longitudinal Tobacco Cessation Pharmacotherapy
65 Chapter 65: Chronic Dermatologic Conditions
65.1 Acne Vulgaris, Rosacea & Seborrheic Dermatitis 65.2 Chronic Plaque Psoriasis & Biologic Therapies 65.3 Chronic Eczema, Hidradenitis Suppurativa & Cutaneous Lupus
66 Chapter 66: Chronic Reproductive, Infectious & Geriatric Special Care
66.1 Chronic Menstrual Disorders, Infertility & Sexual Dysfunction 66.2 Menopause Management & Hormone Replacement Therapy 66.3 Chronic HIV Infection Management & Primary Care Integration 66.4 Gender-Affirming Primary Care & Hormone Therapy 66.5 Advance Care Planning, Palliative Care & End-of-Life Symptom Control
67 Chapter 67: Continuity Care: Sleep, Fatigue, Cancer, Pregnancy & the Adult Preventive Visit
67.1 Chronic Insomnia & Obstructive Sleep Apnea 67.2 Chronic Malaise, Fatigue & ME/CFS 67.3 Primary Care During Cancer Treatment & Survivorship 67.4 Routine Prenatal Care & Longitudinal Pregnancy Management 67.5 The Periodic Adult Health Examination & Medicare Annual Wellness Visit
67.5 The Periodic Adult Health Examination & Medicare Annual Wellness Visit
Key Takeaways Explain This Topic AI
The value of the periodic adult health examination lies in delivering graded preventive services; general health checks in asymptomatic adults have not been shown to reduce all-cause, cardiovascular, or cancer mortality.
The Initial Preventive Physical Examination (G0402) is a once-per-lifetime service available only within the first 12 months of Medicare Part B enrollment, while the initial Annual Wellness Visit (G0438) requires more than 12 months of Part B and subsequent visits use G0439.
The Annual Wellness Visit is not a physical examination, and Original Medicare does not cover the routine comprehensive annual physical billed under CPT 99381 to 99397.
Required Annual Wellness Visit elements include a health risk assessment, cognitive impairment detection, depression risk review, functional and fall-risk assessment, and a written screening schedule for the next 5 to 10 years.
Screening electrocardiography in asymptomatic low-risk adults and screening for asymptomatic carotid artery stenosis both carry USPSTF Grade D recommendations and do not belong in the routine adult examination.
Last updated: September 2026
The Visit Itself Is a Blueprint Activity
The ABFM blueprint lists "general adult medical exam" as its own Preventive Care clinical activity, separate from every individual screening test. That is a meaningful distinction. The examination expects you to know not only which services are recommended, but how the preventive encounter is structured, what it is called, what it must contain, and what it should not contain .
The core insight, well supported by evidence, is that the value of the periodic health examination lies in the delivery of evidence-based preventive services — not in the head-to-toe physical examination . Systematic reviews of general health checks in asymptomatic adults have not demonstrated reductions in all-cause, cardiovascular, or cancer mortality. What does change outcomes is reliably delivering the graded screening, immunization, and counseling services that the visit is an opportunity to organize.
The Three Medicare Visits — and the One Medicare Does Not Cover
This is the single most commonly tested piece of preventive-visit administration in family medicine.
Service Code Eligibility Frequency
Initial Preventive Physical Examination (IPPE) — the " Welcome to Medicare " visit G0402 Only within the first 12 months of Medicare Part B enrollment Once per lifetime
Initial Annual Wellness Visit (AWV) G0438 After the patient has had Part B for more than 12 months ; not within 12 months of a G0402 Once per lifetime
Subsequent Annual Wellness Visit G0439 At least 12 months after the previous AWV Annually
Routine comprehensive annual physical 99381–99397 Commercial, Medicaid, and many Medicare Advantage plans Not covered by Original Medicare
Important
The Annual Wellness Visit is not a physical examination. Beyond height, weight, BMI, blood pressure, and other routine measurements as appropriate, no hands-on examination is required. Medicare does not cover the traditional head-to-toe annual physical (CPT 99381–99397), and billing one as an AWV is a compliance problem. If a medically necessary problem-oriented evaluation occurs at the same encounter, the separate E/M service is reported with modifier -25 .
The AWV carries no copayment, coinsurance, or deductible for the beneficiary when billed correctly — a point worth communicating in advance, because unexpected cost-sharing after a "free wellness visit" is one of the most common patient-billing complaints in primary care.
Required elements of the Annual Wellness Visit
Administer or update a health risk assessment (HRA) .
Establish or update medical and family history .
Establish or update a list of current providers and suppliers .
Record height, weight, BMI, blood pressure , and other routine measurements as appropriate.
Detect cognitive impairment through direct observation and information from patients, family, or caregivers.
Review potential risk factors for depression and other mood disorders.
Assess functional ability and level of safety — activities of daily living, fall risk , hearing impairment, and home safety.
Establish a written screening schedule for the next 5 to 10 years .
Establish a list of risk factors and conditions with recommended interventions.
Furnish personalized health advice and appropriate referrals to health education or preventive counseling.
Offer voluntary advance care planning (billed separately when performed and documented).
Structuring the Preventive Visit for Any Adult
Whatever the payer, a defensible periodic adult health examination covers five domains:
Domain Content
Screening Age- and risk-appropriate USPSTF services: blood pressure, lipids, diabetes, colorectal, breast, cervical, lung, and prostate cancer as indicated, AAA, osteoporosis, hepatitis C, HIV, and STI screening
- Immunization The current ACIP adult schedule by age and condition
- Counseling Tobacco, alcohol, diet, physical activity, sexual health, injury prevention, firearm safety
Chemoprophylaxis Statin therapy by ASCVD risk, low-dose aspirin where indicated, folic acid in patients who could become pregnant
Psychosocial Depression and anxiety screening, intimate partner violence, social determinants, caregiver strain, advance care planning
Behavior-change counseling is delivered through the 5 A's framework: Ask, Advise, Assess, Assist, Arrange .
What Does Not Belong in the Routine Adult Exam
Low-value services attached to the annual visit are a rich source of examination questions because they feel thorough and are not.
Routine annual laboratory panels — CBC, comprehensive metabolic panel, and urinalysis in asymptomatic adults have no demonstrated benefit and generate incidental abnormalities.
Screening resting or exercise electrocardiography in asymptomatic adults at low cardiovascular risk carries a USPSTF Grade D recommendation; the evidence is insufficient (I) at intermediate or high risk.
Screening for asymptomatic carotid artery stenosis in the general adult population carries a USPSTF Grade D recommendation — carotid auscultation and carotid duplex are not screening tools for asymptomatic adults.
Routine chest radiography , routine vitamin D screening in asymptomatic adults, and routine pelvic examination in asymptomatic non-pregnant women are not evidence-supported components of the preventive visit.
Prostate-specific antigen without shared decision-making , and PSA in men older than 70, conflict with the graded recommendation.
The correct framing for the ABFM examination is not "do less," but "replace ritual with graded services." The visit that omits the annual ECG and instead completes overdue colorectal screening, updates the pneumococcal and RSV vaccines, screens for depression, and reconciles medications is the higher-value encounter.
Continuity, Documentation and Equity
Every preventive encounter is a care-gap closure opportunity. Registry and EHR-driven gap lists routinely outperform memory; the most common failure of the annual visit is not a missed diagnosis but an unaddressed overdue screen.
Medication reconciliation — including over-the-counter agents, supplements, and deprescribing review against the AGS Beers Criteria in older adults — belongs in every periodic examination.
Advance care planning should be offered longitudinally rather than deferred to a crisis, and it is a required optional element of the AWV.
Access equity matters : uninsured and underinsured adults, patients with limited English proficiency, and patients with disabilities have systematically lower preventive-service completion. Building in interpretation, transportation, and reminder systems is part of the clinical work, not an administrative afterthought.
Board Exam Traps
A patient enrolled in Medicare Part B 4 months ago requests a wellness visit → this is the IPPE (G0402) , not an AWV; G0438 requires more than 12 months of Part B.
A patient who had an initial AWV 2 years ago → bill G0439 , the subsequent AWV; G0438 is once per lifetime.
"Medicare will cover my annual physical" → Original Medicare covers the IPPE and the AWV, not the routine comprehensive physical (99381–99397).
Screening ECG in a 55-year-old asymptomatic low-risk adult → USPSTF Grade D ; do not order it.
Carotid bruit auscultation offered as a screening strategy in an asymptomatic adult → screening for asymptomatic carotid stenosis is Grade D .
The AWV "physical exam" question → the AWV requires measurements, cognitive impairment detection, and a written 5- to 10-year screening schedule, not a comprehensive examination.