Annual Wellness Visit Billing Codes (G0438, G0439) for Medicare

Medicare's annual wellness visit is billed with HCPCS code G0438 for the patient's first AWV ever and G0439 for every AWV after that, once every 12 months. A problem-oriented visit on the same day is billed separately as an office E/M (99202–99215) with modifier 25, and advance care planning (99497) can be added with modifier 33 so the patient pays nothing for it.

G0438 vs G0439

Both codes describe the same benefit: a visit to create or update a personalized prevention plan, built around a health risk assessment. The difference is which visit it is in the patient's Medicare lifetime.

The first AWV does more work (it establishes the history, lists and baseline measurements), which is why G0438 carries more RVUs than G0439. The Claims Processing Manual is direct about the new-practice case: "In the event that a beneficiary selects a new health professional to complete a subsequent AWV, the new health professional will continue to bill the subsequent AWV with HCPCS G0439" (ch. 12, §30.6.1.1).

Sources: CMS, Annual Wellness Visit (cms.gov/medicare/coverage/preventive-services/medicare-wellness-visits/annual-wellness-visit, modified April 9, 2026); Medicare Claims Processing Manual, Pub. 100-04, ch. 12, §30.6.1.1 and ch. 18, §140 (Rev. 13709, April 2, 2026). Verified October 6, 2026.

Which code? Check eligibility first

Eligibility comes from 42 CFR 410.15: the patient must be past the first 12 months of their first Part B coverage period and must not have had an IPPE or an AWV in the past 12 months. Medicare's edits count 12 months back from the date of service.

Who can perform the AWV

Part B covers an AWV furnished by a physician; a physician assistant, nurse practitioner or clinical nurse specialist; or a medical professional such as a health educator, registered dietitian or other licensed practitioner, or a team of them, directly supervised by a physician (CMS AWV page). CMS doesn't require a specific diagnosis code: report any diagnosis consistent with the visit.

AWVs can be furnished via telehealth: CMS states "We pay for G0438 and G0439 when you provide services via telehealth," and both codes are on the CY 2026 Medicare telehealth services list. In an FQHC, the AWV is billed with G0468; in an RHC, it's paid under the all-inclusive rate.

What's not covered in the annual wellness visit

The AWV is a planning visit, not an exam. What falls outside it:

• A routine physical exam. Medicare.gov says the AWV "isn't a routine physical exam," and CMS lists the routine physical as not covered, with the patient paying 100%. Don't bill an AWV with the preventive medicine codes 99381–99397 (ch. 12, §30.6.1.1).
• Labs and other tests. Screening labs, an EKG or imaging ordered at the visit are separate services with their own coverage rules and cost sharing. Medicare.gov: "You may have to pay coinsurance, and the Part B deductible may apply if your provider performs additional tests or services during the same visit."
• Treating problems. Evaluating a new symptom or managing a chronic condition is an E/M service, not part of the AWV, and the patient's coinsurance applies to it.
• A second AWV within 12 months, or any AWV inside the first 12 months of Part B.

Tell patients before the visit what's free and what isn't: CMS asks practitioners to help patients understand when a recommended service may cost them some or all of its price.

Adding a problem visit: modifier 25

When the patient needs care for a problem during the AWV, CMS allows separate payment for a significant, separately identifiable and medically necessary E/M service. Report the additional billing code (99202–99205, 99211–99215) with modifier 25.

1. Bill the AWV: G0438 or G0439, one unit.
2. Bill the E/M with [modifier 25](/modifiers/25), leveled on the problem-oriented work. The note should show care that was medically necessary for an illness or injury, separate from the AWV's prevention work.
3. Add G2211 to the E/M if you're the patient's continuing focal point for care. Since January 1, 2025, Medicare pays G2211 with a modifier 25 E/M when the other service is an AWV (CY 2025 PFS final rule, 89 FR 97858). See [the G2211 guide](/guides/g2211).
4. Add ACP if you had the conversation, with modifier 33 (below).

Advance care planning (99497) with the AWV

Advance care planning is an optional AWV element offered at the patient's discretion: a conversation about the patient's wishes for future treatment if they can't decide for themselves, including advance directives. It's billed with 99497 for the first 30 minutes and 99498 for each additional 30 minutes.

Medicare waives the coinsurance and deductible for ACP when it's delivered on the same day by the same provider as the AWV and billed with modifier 33 on the same claim. The waiver applies once a year with the AWV. If the AWV denies for frequency, the ACP's cost sharing comes back; ACP outside the AWV always carries normal cost sharing. There's no limit on how often ACP can be billed, but each time the record should show a change in health status or wishes (CMS AWV page).

The same modifier 33 waiver applies to G0136, the optional physical activity and nutrition risk assessment added to the AWV.

Sources: CMS Annual Wellness Visit page (April 9, 2026); 42 CFR 410.15; Medicare.gov, Yearly "Wellness" visits; Claims Processing Manual ch. 18, §140.6–140.7; CY 2025 PFS final rule, 89 FR 97858; CMS CY 2027 PFS proposed rule fact sheet (July 14, 2026). Verified October 6, 2026.

CMS's CY 2027 proposed rule (July 14, 2026) would create two new HCPCS codes for ACP furnished by clinical staff and limit 99497 and 99498 to time the billing practitioner spends personally. That's a proposal, not current policy.

For a full year of AWV, E/M and ACP rates at your locality, build a fee sheet with every code your clinic bills.