Medicare Annual Wellness Visit Billing: G0438, G0439 and How to Do It Right
The AWV is fully covered, well paid, and pairs beautifully with a same-day problem visit — yet practices routinely under-bill it or fail the documentation. Here is the complete 2026 coding and compliance guide.
The Annual Wellness Visit is a rare win-win: patients pay nothing, Medicare pays you well, and it is the perfect hub for preventive care and chronic-condition management. Yet many practices leave it uncaptured, mis-code the initial vs. subsequent visit, or accidentally trigger a copay. Here is how to run it cleanly.
The AWV code set
| Code | Visit | Approx. pay |
|---|---|---|
| G0402 | IPPE ("Welcome to Medicare", first 12 months) | — |
| G0438 | Initial AWV (after 11 months of Part B) | ~$175 |
| G0439 | Subsequent AWV (each year after) | ~$120 |
| G0468 | FQHC add-on (IPPE/AWV bundle) | Add-on |
All are covered at 100% with no patient cost-sharing when billed correctly.
Required components (miss one, risk the claim)
- A Health Risk Assessment (HRA), ideally completed before the visit.
- A personalized prevention plan — the centerpiece — with screenings, risk factors, and interventions.
- Review of medical/family history, current providers, and medications.
- Vitals, a cognitive impairment assessment, and a screening schedule for the next 5–10 years.
The AWV is a checklist visit. Miss a required element and you've created audit exposure on a service that should be effortless.
Pairing with a same-day problem visit
The AWV is not a physical, and it is not a problem visit. But if the patient also has a medically necessary issue, you can bill a separate E/M with modifier 25 on the same day — and you may also append G2211, which remains payable alongside an AWV. Done right, one appointment produces two appropriate lines of revenue. See our modifier 25 guide for the details.
Rules and common mistakes
Bill G0438 once (initial), then G0439 every year — swapping them is a frequent denial. Don't bill an AWV within 12 months of the IPPE or a prior AWV. And don't let a wellness visit quietly become a problem visit without the modifier-25 E/M to support it. Clean capture here is a quick win that disciplined coding locks in.
Capturing every AWV — and the same-day E/M?
We'll check your preventive-visit capture rate for free.
The bottom line
The AWV is fully covered, well paid, and a natural launchpad for CCM, screenings, and G2211. Nail the initial-vs-subsequent coding, hit every required component, and capture the same-day problem visit when it's warranted. Want a capture-rate check? Start with a free billing audit.
Sources
Frequently asked questions
G0402 for the initial "Welcome to Medicare" IPPE, G0438 for the first Annual Wellness Visit, and G0439 for each subsequent AWV. FQHCs use add-on G0468. G0438 pays roughly $175 and G0439 roughly $120, both with no patient cost-sharing.
No. The Annual Wellness Visit is a Part B preventive service covered at 100% with no deductible or coinsurance — as long as it is billed correctly and not converted into a problem-based visit.
Yes. If you also address a separate, medically necessary problem, you may bill an E/M with modifier 25 in addition to the AWV. The problem-based portion may carry normal cost-sharing.
Only once per 12-month period. G0438 is billed once (after 11 months of Part B enrollment); every AWV after that is G0439.
See where your practice is leaking revenue.
A free, no-obligation billing audit shows exactly what the 2026 changes mean for your bottom line.
