The CPT code for annual wellness visit billing under Medicare is G0402 (first visit) and G0439 (subsequent visits). These are HCPCS Level II codes, not CPT codes, and a common reason for denials with preventive care is mixing them up with the codes for a regular physical exam.
To bill AWVs correctly in 2016, providers must also follow Medicare’s documentation and eligibility guidelines. The health risk assessment, prevention plan, and screening are required.
What Is the CPT Code for An Annual Wellness Visit Under Medicare?
The CPT codes for the annual wellness visit are:
- G0438: for the first AWV
- G0439: for subsequent AWV
They are paid at 100% by Medicare Part B, with no patient cost-sharing, assuming the following conditions are met.
The annual wellness visit CPT codes are G0438 (first AWV) and G0439 (subsequent AWV). Medicare Part B will pay 100% (no cost sharing) of the visit if the following conditions apply.
These are HCPCS, not AMA CPT. That’s a critical factor when you bill for services. The Centers for Medicare & Medicaid Services (CMS) says these codes provide a personalized prevention plan of services (PPPS) and an organized health risk assessment (HRA).
CPT codes for annual physicals (such as 99395-99397) are not reimbursed by Medicare for Medicare beneficiaries. Billed to Medicare as a wellness visit, they are either denied or charged to the patient.
Table: 2026 Annual Wellness Visit CPT Codes
| Code | Visit Type | Eligibility Window | 2026 National Avg. Reimbursement |
| G0402 | Initial Preventive Physical Exam (IPPE / “Welcome to Medicare”) | Within the first 12 months of Part B enrollment | $174 |
| G0438 | Initial Annual Wellness Visit | After 12 months of Part B enrollment (once per lifetime) | $174 |
| G0439 | Subsequent Annual Wellness Visit | Every 11+ months after G0438 (repeats annually) | $138 |
| 99395–99397 | Preventive Physical (commercial payers) | Per payer policy—NOT covered by standard Medicare | Varies by payer |
G0402 vs. G0438 vs. G0439: Which Code Applies?
This error cannot be corrected later. See the following differences:
G0402 – “Welcome to Medicare” IPPE
This code is only used in the first 12 months of Part B eligibility. It is a once-in-a-lifetime benefit. If a patient does not get it within 12 months, they are ineligible for G0402 permanently.
G0438 – Initial Annual Wellness Visit
This code is used after the initial 12 months of Part B coverage and only if the patient has not had a G0438 in the past. If the patient had a G0402, then the G0438 is available on the first day of the month in the next year. G0438 is a one-time code as well.
G0439 – Subsequent Annual Wellness Visit
G0439 is the code to bill for all subsequent AWVs. You can bill this code 11 months after the last AWV. This will be the most common code used. According to CMS, G0438 or G0439 can only be billed once every 12 months; if you bill outside this time frame, the claim will be denied.
Medicare Annual Wellness Visit Checklist for Providers
Documentation is the main reason for AWV denials. 42 CFR § 410.15 requires everything to be documented in the patient’s record before you bill.
One survey noted that 85% of Medicare annual wellness visits could be non-compliant with the CMS due to inadequate documentation.
Elements for G0438 (Initial AWV)
- Health Risk Assessment (HRA)
- Past medical and family history
- Biometric data
- Screening for dementia
- Risk factors for depression
- Functioning and safety
- Personalized Prevention Plan (PPPS)
- Screening and interventions
- Advance care planning (ACP) discussion
Required Elements for G0439 (Subsequent AWV)
On subsequent visits, providers update all elements. This results in more efficient subsequent AWVs but still requires complete documentation.
- Updated HRA
- Updated medical and family history
- Updated medication and supplement list
- Updated biometric measurements
- Screening for cognitive impairment (observation)
- Updated PPPS (new schedule)
- Updated list of risk factors and interventions
- ACP discussion (optional, billable)
Annual Physical CPT Code vs. AWV: Key Differences
Many doctors and patients refer to an “annual physical” and “annual wellness visit” interchangeably. These are not the same; if you do it wrong, there will be consequences.
| Feature | Annual Wellness Visit (G0438/G0439) | Annual Physical (99395–99397) |
| Payer | Medicare Part B | Commercial/private insurance |
| Focus | Prevention plan, HRA, risk screening | Comprehensive physical exam |
| Patient cost-sharing | $0 (no deductible, no copay) | Per-plan benefits |
| Physical exam required? | No head-to-toe exam required | Yes, a comprehensive exam is required |
| Cognitive screening | Required | Not a standard requirement |
| Reimbursement source | HCPCS G-codes | AMA CPT codes |
The annual physical CPT code (99397 if the patient is over 65) is a preventive E/M code. It is used for commercial practices. It is not a covered service for Medicare fee-for-service beneficiaries.
Billing an AWV with an E/M on the Same Day
AWVs and problem-oriented evaluation and management (E/M) services can be billed on the same day if they are medically necessary and well documented.
Here’s what CMS says to do:
- Bill G0438 or G0439 for the AWV portion of the visit.
- Use the modifier 25 with E/M codes (99202-99215).
- Include a note justifying the E/M service.
- Assign an appropriate diagnosis code.
Medicare Advantage plans have different bundling rules. Check with the plan for this information.
Add-On Codes Billable With the Annual Wellness Exam
There are many preventive services that can be billed with the annual wellness exam to enhance the visit and address gaps in the patient’s care.
- G0444: Annual depression screening (15 minutes). Allowed with G0439 only.
- G0442 + G0443: Annual screening for alcohol misuse . 15-minute alcohol counseling.
- G0447: 15-minute obesity/nutritional counseling.
- 99497: Advance care planning (30 minutes face-to-face). When billed with AWV on the same day, the deductible and coinsurance are waived (modifier 33).
- G2211: Longitudinal primary care add-on. This can be used with AWV-related E/M visits for Medicare patients starting in 2015.
- G0468: FQHC-specific add-on. This is used by Federally Qualified Health Centers (FQHCs) to receive FQHC-specific rates in addition to G0402, G0438, or G0439.
Common AWV Billing Errors That Cause Claim Denials
The following errors can cause claim denials. They can be prevented with training and adherence to a compliant process.
- Using G0438 when G0439 is required: G0438 is a lifetime code. It will be denied if billed twice for the same beneficiary. If the beneficiary has had an initial AWV, bill G0439.
- Billing within the 12-month limit: CMS does not permit AWV claims to be billed until 11 months from the last G0438 or G0439. Check with HETS on the last date of AWV.
- 3. Billing G0439 when no G0438 is on file: G0439 is the follow-up code to G0438. If the patient is on Medicare but has no G0438, the G0438 should be billed.
- Incomplete documentation: If any element is not documented (cognitive screening, PPPS), a post-payment audit will be performed, and the payment will be recouped. Document elements with a template.
- Billing G0444 with G0438: Depression screening (G0444) can only be billed with an AWV (G0439). This is rejected when billed with the initial visit.
- Billing 99397 (annual physical) or other preventive CPT codes for Medicare: Medicare does not cover initial or subsequent preventive annual physicals (CPT). This leads to patient compliance and cost issues, rather than AWV HCPCS codes.
Is Your Practice Leaving AWV Revenue on the Table?
Are you losing AWV revenue opportunities? The reasons can be denials, under-coding, or documentation loopholes. To avoid this, choose a reliable billing partner with proven expertise in Medicare preventive services.
At Kansas Medical Billing, we specialize in Medicare billing compliance for physician practices. Our services include accurate annual wellness visit coding, documentation review, and denial management. Our team verifies G0438/G0439 eligibility before the visit. We make sure to submit clean claims the first time.
Get a free AWV billing audit for your practice.
Contact Kansas Medical Billing Today
Frequently Asked Questions
1. What is the difference between G0438 and G0439?
G0438 is the initial Medicare AWV, billed once after 12 months of Part B enrollment. G0439 is for subsequent visits, allowed every 11+ months thereafter.
2. Can I bill a problem-oriented E/M visit on the same day as an AWV?
Yes. Bill AWV with G0438/G0439 and E/M (99202–99215) with Modifier 25. The E/M must be medically necessary, separately documented, and diagnosis-specific.
3. Does Medicare cover the annual wellness visit at 100%?
Yes. Medicare covers AWVs at 100% with no copay or deductible if assignment is accepted. Cost-sharing applies only to separately billed problem-oriented E/M services.
4. Can a nurse practitioner bill for an annual wellness visit independently?
Yes. NPs, PAs, and CNSs can bill AWVs under their own NPI per CMS rules and state laws, with required supervision for staff-performed components.
5. What happens if a required AWV element is missing from documentation?
Missing elements increase audit risk. CMS may recoup payments if documentation is incomplete, indicating non-compliance. Use structured templates aligned with all required AWV components.
