Guide

G0438 and G0439: the annual wellness visit, done right

Summary

G0438 bills a patient's first annual wellness visit with your practice; G0439 bills every one after that, each payable once every 12 months when the visit meets Medicare's content and eligibility rules. Both are Part B preventive benefits with no deductible or coinsurance when billed correctly. Confirm which code applies and whether the frequency window has actually been met before the visit, not after a denial — Medicare's own coverage instructions, not a guess, settle both questions.

By Gale Editorial · Updated 2026-07-26. Every figure cited to a dated source. How we write.

How do I bill Medicare's annual wellness visit?

Two HCPCS codes cover it: G0438 for a patient's first annual wellness visit with you, and G0439 for every visit after that, each payable once every 12 months when the visit meets Medicare's eligibility and content requirements. Both are Part B preventive benefits carrying no deductible or coinsurance when billed correctly, which is exactly why getting the billing right matters more than for an ordinary office visit — a coding slip turns a free benefit into a surprise bill.

The sections below cover which code applies and how often, why this visit is not a physical exam even though patients often assume it is, how to confirm eligibility before the visit rather than after a denial, and where Medicare actually publishes the current payment amount instead of a figure worth memorizing.

G0438 versus G0439: which code, and how often

G0438 bills a patient's very first annual wellness visit performed by you or your practice; every visit after that, for that same patient, bills as G0439, regardless of whether an earlier AWV happened somewhere else. Billing G0438 for a patient who already had a qualifying AWV elsewhere, or billing G0439 before a first one ever happened, is one of the more common reasons an AWV claim comes back denied instead of paid.

Whether a given patient already has a qualifying AWV on record, and how Medicare counts the 12-month window between visits, is defined in Medicare's own coverage instructions rather than left to convention 1. The safer habit for a solo practice is checking a new patient's AWV history — through their prior records or a quick coverage check — before the visit is scheduled, not after the claim comes back.

This isn't a physical, and coding it like one is a mistake

The annual wellness visit is not a hands-on physical exam, and Medicare does not pay for a routine annual physical the way many patients assume it does. That distinction — the awv is not a physical — is why coding this visit as a routine checkup is the single most common way the benefit goes wrong at the front desk, and it is detailed enough to warrant its own read before staff ever book the visit that way.

What G0438 and G0439 actually buy is a structured prevention visit built around a health risk assessment and an updated prevention plan, not a physical examination and not a venue for working up a new symptom. When a patient brings a genuine medical complaint to that same appointment, the visit typically splits into two billable pieces rather than folding into one — a wrinkle worth understanding before it happens mid-visit rather than after.

Confirming coverage before you bill, not after

The exact eligibility rules for G0438 and G0439 — who qualifies, how the frequency window is counted — live in Medicare's coverage instructions, and reading them directly beats trusting a secondhand summary passed down from a prior job or an old training slide 1. Any jurisdiction-specific coverage article or local coverage determination touching preventive visits is searchable in the Medicare Coverage Database, which indexes both national coverage decisions and the coverage articles your own Medicare Administrative Contractor has published 2.

Because Medicare regionalizes claims administration, the coverage guidance and enrollment mechanics that actually bind your claims come from your own MAC, not a generic national answer — CMS publishes which MAC serves each jurisdiction, and that MAC's own site is the place to confirm anything jurisdiction-specific before it becomes a pattern of denials 3.

What Medicare pays, and how to look it up

What G0438 and G0439 actually pay is not a number worth memorizing, since Medicare's rates update annually and vary by locality. CMS publishes a public Physician Fee Schedule Search tool where any clinician can look up the current national and locality-adjusted payment amount, along with the relative value units behind it, for either code 4.

Building the habit of checking that tool directly — rather than relying on last year's number or a billing service's cached figure — matters more for preventive codes like these than for most, because the payment schedule is revised through annual rulemaking and a stale number quietly under- or over-estimates what a visit is actually worth to the practice.

When you're not sure the visit qualifies: the ABN

If there is real doubt about whether a specific AWV will meet Medicare's frequency or eligibility rules — a patient who is unsure whether they had one elsewhere in the last 12 months, for instance — that uncertainty is exactly the situation an Advance Beneficiary Notice of Noncoverage exists for. CMS's Beneficiary Notices Initiative publishes the ABN form and the instructions for when it is required before billing a Medicare patient for a service that may be denied 5.

Issuing the ABN before the visit, not after the denial arrives, is what actually protects the practice's ability to bill the patient directly if Medicare turns out not to cover that particular visit. Skipping it on a visit with genuine doubt is the more expensive mistake — the practice absorbs the cost of a denied claim instead of the patient sharing it.

Delivering the AWV by telehealth

Whether G0438 and G0439 currently qualify for delivery by telehealth is worth checking before scheduling one that way rather than assuming, since Medicare's list of covered telehealth services changes from year to year and distinguishes permanent additions from temporary ones. CMS publishes the definitive current list, including which codes require video versus which may be delivered audio-only 6.

For a solo practice weighing whether to offer the AWV virtually, that list — not last year's flexibility, not a colleague's practice — is the source that actually controls whether the claim gets paid. Checking it each time a scheduling policy is set, rather than once and then forgetting it, avoids building a workflow around a rule that has since changed.

Common questions

G0438 bills a patient's first annual wellness visit with your practice. G0439 bills every AWV after that for the same patient, regardless of whether the first one happened somewhere else. Billing the wrong one — G0438 for a patient who already had a qualifying AWV, or G0439 before a first one ever occurred — is a common reason these claims come back denied.

Once every 12 months per patient, counted from their prior AWV rather than the calendar year. The exact frequency and eligibility rules live in Medicare's own coverage instructions, so confirming a specific patient's history before scheduling the visit is safer than assuming a year has passed since their last one.

No. The AWV is a structured prevention visit built around a health risk assessment and prevention plan, not a hands-on physical exam, and Medicare does not cover a routine annual physical the way many patients expect. Coding the AWV as if it were a physical exam is one of the more common billing mistakes on this benefit.

Use CMS's Physician Fee Schedule Search tool, which shows the current national and locality-adjusted payment amount and RVUs for any code. Rates update through annual rulemaking, so a number from last year, or from a billing service's cached list, can quietly be stale by the time you rely on it.

Only when there's genuine doubt the visit will meet Medicare's coverage rules — for example, a patient unsure whether they had an AWV elsewhere within the last 12 months. Issuing an Advance Beneficiary Notice before that visit protects your ability to bill the patient directly if Medicare later denies it; skipping it leaves the practice absorbing that cost instead.

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References

  1. 1.Centers for Medicare & Medicaid Services (2026). Internet-Only Manuals (IOMs). Centers for Medicare & Medicaid Services (CMS). link ✓That CMS's operative coverage and billing instructions, including the Benefit Policy Manual, live in the public Internet-Only Manuals rather than a secondhand summary, used here to ground checking a patient's AWV eligibility and frequency history against the source instructions before billing G0438 or G0439.
  2. 2.Centers for Medicare & Medicaid Services (2026). Medicare Coverage Database (MCD) Search. Centers for Medicare & Medicaid Services (CMS). link ✓That national coverage decisions and each MAC's own coverage articles are searchable in the public Medicare Coverage Database, used here as the lookup method for any jurisdiction-specific AWV coverage guidance.
  3. 3.Centers for Medicare & Medicaid Services (2026). Medicare Administrative Contractors. Centers for Medicare & Medicaid Services (CMS). link ✓That Medicare claims administration is regionalized across Medicare Administrative Contractors and CMS publishes which MAC serves each jurisdiction, used here to point the reader to their own MAC as the source for jurisdiction-specific AWV billing guidance.
  4. 4.Centers for Medicare & Medicaid Services (2026). Physician Fee Schedule Search. Centers for Medicare & Medicaid Services (CMS). link ✓That CMS publishes a public Physician Fee Schedule look-up tool showing the current national and locality payment amount and RVUs for any code, used here as the method for finding what Medicare currently pays for G0438 or G0439 rather than relying on a memorized or stale figure.
  5. 5.Centers for Medicare & Medicaid Services (2026). Beneficiary Notices Initiative (BNI). Centers for Medicare & Medicaid Services (CMS). link ✓That the Advance Beneficiary Notice of Noncoverage and its instructions are published under CMS's Beneficiary Notices Initiative and govern when it must be issued before billing a Medicare patient for a service that may be denied, used here for AWVs with genuine frequency or eligibility doubt.
  6. 6.Centers for Medicare & Medicaid Services (2026). List of Telehealth Services. Centers for Medicare & Medicaid Services (CMS). link ✓That CMS publishes the definitive, year-to-year list of codes payable as Medicare telehealth, including permanent-versus-temporary status and audio-only eligibility, used here as the check before scheduling an AWV to be delivered by telehealth. As of July 2026.

https://www.gale.care/for-providers/em-awv-g0438-g0439 · 6 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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