HCPCS G0438: Annual wellness visitMedicare rate & RVUs

Medicare pays $174.35 for G0438 nationally in the office. Local office rates run $160.06–$220.54.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0438 covers

The initial Medicare Annual Wellness Visit is preventive planning, not a head-to-toe physical. A physician, nurse practitioner, physician assistant, clinical nurse specialist, or medical professional under a physician’s direct supervision, such as a health educator or registered dietitian, usually furnishes it in primary care. Required elements include a health risk assessment, medical and family history, a list of providers and suppliers, routine measurements, cognitive and depression-risk assessments, functional and safety review, review of opioid prescriptions and substance use risk, and a written screening schedule and personalized prevention plan.

Report G0438 for the beneficiary’s first AWV with any practice, once per lifetime, after more than 12 months of Part B coverage and at least 12 months after any IPPE. Use G0439 for later AWVs. Document the assessment, required elements, and written plan furnished to the patient. Medicare waives the AWV deductible and coinsurance. A separately supported problem-oriented E/M visit can be reported with modifier 25 on the E/M; its usual cost sharing remains. If separately furnished with the AWV, advance care planning may be reported with 99497 and modifier 33 for its cost-sharing waiver.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0438 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0438 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0438 rate is calculated

Each of G0438’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0438

G0438 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

G0438 compared with similar codes

How to choose

G0439Annual wellness visit

G0438 is the once-per-lifetime first AWV; G0439 covers later annual wellness visits. Check for any prior AWV before choosing G0438.

G0402Welcome visit

G0402 is the IPPE, available only within the first 12 months of Part B coverage. G0438 requires more than 12 months of Part B coverage and at least 12 months since any IPPE.

99397Per pm reeval est pat 65+ yr

99397 is a routine preventive physical for established patients aged 65 and older, which Original Medicare does not cover as a preventive benefit. G0438 is the Medicare wellness planning visit.

Codes related to G0438

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates