Is AI Coming To The Medicare Annual Wellness Visit?

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CMS has asked whether clinical AI tools could make Medicare Annual Wellness Visits more continuous and tailored to beneficiaries. The agency has not proposed removing the requirement for a Medicare-enrolled physician or other health professional to perform the visit, and the American Academy of Family Physicians says AI should support, not weaken, established primary care relationships.

The Centers for Medicare & Medicaid Services is asking whether artificial intelligence tools could help reshape Medicare Annual Wellness Visits, a preventive care benefit used by about half of seniors, according to CMS deputy administrator Stephanie Carlton. The agency is seeking input through its proposed physician payment rule; it has not announced a change to the current requirement that a Medicare-enrolled physician or other health professional perform the visit.

CMS said the evidence on whether the Annual Wellness Visit (AWV) improves health outcomes is mixed. In the proposed rule, the agency noted studies linking AWV receipt with increased use of preventive services, while also citing research that found no substantive association with better evidence-based screening, acute care use or spending. Some studies raised the possibility of increased downstream use of low-value services. CMS said the findings prompted it to ask whether clinical AI could make the AWV a more continuous, data-driven and beneficiary-specific preventive care function.

The agency listed possible uses including collecting beneficiary-reported information before a visit, identifying people who may need additional assessment and generating suggested follow-up steps for clinicians to review. At the Health Datapalooza conference in Washington, D.C., Carlton said, “Only about half the seniors use [the AWV], and we don’t have good evidence that it’s actually resulting in better outcomes.” She described that as an opportunity for AI. Her remarks describe a potential role for the tools; CMS has not said they will be adopted.

CMS emphasized that under current policy, the AWV must be performed by a physician or other health professional, or a team of medical professionals directly supervised by a physician enrolled as a Medicare provider. The agency is asking whether that framework creates barriers to models in which an AI company develops or operates tools and affiliates with an enrolled provider or supplier. That question does not itself establish that an AI company may independently provide the visit.

AI Could Change How Visits Work

The discussion could affect how preventive information is gathered and how care teams identify gaps before or after an AWV. If AI tools help organize beneficiary responses or flag potential follow-up, they could support clinicians in coordinating preventive care. The American Academy of Family Physicians said such uses might reduce administrative burden and give physician-led teams more capacity for timely, coordinated care.

The policy question also concerns who remains accountable for clinical decisions and follow-up. The AAFP cautioned that preventive care involves a patient’s medical history, chronic conditions, behavioral health needs, circumstances and long-term goals, and said those factors require an ongoing relationship with a physician-led team. A model that separates parts of the visit from that relationship could, the academy argued, contribute to fragmented records, duplicate services or uncertainty about responsibility.

The AWV Evidence Behind CMS’s Question

The AWV is a Medicare preventive benefit, but CMS’s proposed rule reflects uncertainty about whether the visit, as currently delivered, consistently improves outcomes. The agency’s description draws a distinction between greater use of preventive services and evidence of broader improvements in screening, acute care use or spending. The studies cited in the rule do not point to a single settled conclusion.

CMS is seeking comment on possible delivery models and the rules governing them. The AAFP, whose members provide AWVs, expressed support for thoughtful AI use in tasks such as identifying eligible patients, summarizing health information, spotting preventive care gaps, supporting documentation and facilitating follow-up. Its position is conditional: technology should strengthen the patient’s existing care team and preserve clinical accountability.

““Evidence regarding the impact of the AWV on outcomes is mixed.””

— CMS proposed physician payment rule

Rules for AI Delivery Remain Open

CMS has asked for feedback, but the source material does not describe a finalized policy authorizing AI companies to furnish AWVs or determining how their tools would be overseen. It is also unclear which AI functions, if any, CMS might permit or encourage, how providers would review suggested follow-up, and how responsibility for that care would be assigned.

The outcome evidence remains unsettled as well. CMS cited studies with different findings about preventive service use, screening, acute care and spending. The available information does not establish whether AI-supported visits would improve patient outcomes, close preventive care gaps or change costs.

Final Payment Rule Due Around November

CMS was expected to issue the final physician payment regulation around Nov. 1, according to the report. That rule would show how the agency responds to feedback on AWV delivery and AI tools. Until then, CMS’s question is a request for input, and the current requirement for a Medicare-enrolled professional to perform the visit remains in place.

Readers should look for whether the final rule addresses provider supervision, the role of technology companies and safeguards for continuity and follow-up. The supplied information does not confirm what the final regulation will say.

Key Questions

Has Medicare approved AI to perform Annual Wellness Visits?

No approval is described in the available information. CMS is asking for feedback on possible uses of AI, while current policy requires a Medicare-enrolled physician or other health professional to perform the AWV.

What could AI do during or around an AWV?

CMS listed possible uses such as collecting beneficiary-reported information before the visit, identifying people who may need more assessment and suggesting follow-up steps for clinicians to review.

Why is CMS asking about AI?

CMS says evidence on AWV outcomes is mixed. Some studies associate the visits with more preventive services, while others do not find substantive links with improved screening, acute care use or spending.

What is the AAFP’s position?

The American Academy of Family Physicians supports thoughtful AI use for tasks such as identifying care gaps and supporting documentation. It says technology should preserve continuity, physician-led care and clear clinical accountability.

When will CMS decide?

The final physician payment rule was expected around Nov. 1, according to the report. The available information does not state what CMS will decide about AI-supported AWVs.

Source: rss