HCPCS G0438: Initial Annual Wellness Visit
HCPCS G0438 is the initial Medicare Annual Wellness Visit (AWV), billed once per lifetime after the first 12 months of Part B coverage. In 2026 Medicare pays about $174.35 (5.22 total RVUs times the $33.4009 conversion factor), the same in facility and non-facility settings.
- Code type
- Initial Annual Wellness Visit (AWV)
- 2026 non-facility
- $174.35 (5.22 RVUs)
- 2026 facility
- $174.35 (5.22 RVUs)
- Frequency
- Once per lifetime, after first 12 months of Part B
What is HCPCS G0438 used for?
G0438 is the initial Medicare Annual Wellness Visit (AWV), a once-per-lifetime prevention-planning visit for beneficiaries who have had Part B for more than 12 months and have not previously had an AWV. It builds the health risk assessment and the written personalized prevention plan that subsequent wellness visits update.
The visit is structured rather than a physical exam. It includes a health risk assessment, a review of medical and family history, current providers and medications, vital signs, cognitive screening, depression and functional screening, and creation of the written personalized prevention plan and screening schedule. Eligibility is tight: the patient must have had Part B for more than 12 months, must not have had a prior AWV, and cannot be within 12 months of a G0402 IPPE.
How much does G0438 pay in 2026?
G0438 carries 5.22 total RVUs in both settings. At the 2026 conversion factor of $33.4009 that is about $174.35, facility and non-facility alike, with no patient cost-sharing as a covered preventive service. It pays more than the subsequent AWV G0439 because the prevention plan is being created rather than updated. See your locality-adjusted rate on the Medicare fee calculator.
Frequency rules and the AWV family
The wellness codes must be sequenced correctly, because each has its own frequency window and billing one out of order draws a clean denial:
| Code | Visit | Frequency |
|---|---|---|
| G0402 | IPPE | Once, first 12 months of Part B |
| G0438 | Initial AWV | Once per lifetime |
| G0439 | Subsequent AWV | Every 12 months thereafter |
Frequently asked questions
A Medicare beneficiary who has had Part B for more than 12 months and has not had a previous Annual Wellness Visit. G0438 is billed only once per patient, ever, for their first AWV. After that, subsequent AWVs use G0439. You also cannot bill G0438 within 12 months of a G0402 (IPPE).
The 2026 national allowed amount is about $174.35 (5.22 total RVUs times $33.4009), the same in facility and non-facility settings. As a preventive service, the AWV generally has no deductible or coinsurance when billed correctly.
G0438 includes a health risk assessment, a review of medical and family history, current providers and medications, vital signs, cognitive screening, depression and functional screening, and the creation of a written personalized prevention plan and screening schedule. It is not a physical exam; it is a structured prevention-planning visit.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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