HCPCS G0439: Subsequent Medicare Annual Wellness Visit — $138 Rate, the 11-Month Rule (2026).
HCPCS G0439 is the Medicare billing code for the subsequent Annual Wellness Visit — every AWV after the initial G0438. It updates the patient's health risk assessment and personalized prevention plan, and is billable once per year provided at least 11 full calendar months have passed since the last AWV. Medicare covers G0439 at 100% with no deductible or coinsurance when billed as a standalone preventive visit.
Quick Answer
What is HCPCS G0439?
HCPCS G0439 is the Medicare code for the subsequent Annual Wellness Visit, reimbursing approximately $138 in 2026 with no patient cost-sharing. It is billable once per year, at least 11 full calendar months after the patient's previous AWV, and updates the health risk assessment, screenings, and written prevention plan from the initial visit (G0438, ~$174). A separately identifiable same-day problem visit is billable with modifier 25 but carries normal cost-sharing, and Advance Care Planning furnished with the AWV has its cost-sharing waived.
Documentation
Documentation requirements.
Updated Health Risk Assessment reflecting changes since the prior AWV
Updated medical and family history
Updated list of current providers, suppliers, and medications
Weight and blood pressure measurements
Cognitive impairment detection by direct observation or a structured tool, with the method documented
Updated written screening schedule (personalized prevention plan) provided to the patient
Updated list of risk factors with recommended interventions, personalized health advice, and referrals
Billing Workflow
How to bill G0439, step by step.
The calendar-month workflow a billing team actually runs — from qualifying the month to the increment math at month close.
Build recall on the 11-month rule
Patients become eligible after 11 full calendar months, not on the anniversary date. Recall outreach in the 12th month keeps visits annual without triggering frequency denials — scheduling a few weeks early is the single most common G0439 denial.
Verify the AWV clock before the visit
An eligibility check shows the date of the last AWV from any provider and the next eligible date. Transferred patients carry their AWV history with them — the clock did not reset when they changed practices.
Update, don't re-create
The subsequent AWV is an update visit: refresh the HRA, history, medication list, screenings, and the written prevention schedule. Reusing last year's plan without documented updates is the element reviewers reject first.
Stack same-day preventive and problem services correctly
ACP (99497) furnished with the AWV waives the patient's ACP cost-sharing. A separately identifiable problem-focused E/M is billable with modifier 25 but carries normal cost-sharing. The AWV itself remains free to the patient either way.
Re-confirm chronic-care enrollment annually
The AWV is the natural annual checkpoint for CCM and PCM: re-verify consent, update the care plan, and enroll newly eligible patients. A practice running AWVs at scale feeds its care-management programs from a visit Medicare already pays ~$138 for.
Scenarios
Common billing scenarios.
Routine annual visit 12 months after the last AWV
BillableA patient had their initial AWV (G0438) last March; this March the practice updates the HRA, history, medications, screenings, and prevention plan. Bill G0439 — more than 11 full months have passed and every update element is documented.
AWV scheduled 10 months after the previous one
Not BillableA patient books their annual visit a few weeks early — 10 months and 3 weeks after last year's AWV. The claim denies on frequency: G0439 requires at least 11 full calendar months since the last AWV. Recall systems should key on the month after the anniversary, not the anniversary date itself.
Transferred patient with AWV history elsewhere
BillableA new patient's eligibility check shows a G0439 billed by their previous practice 13 months ago. Bill G0439 — not G0438, because the initial visit already exists on their lifetime record — and more than 11 full months have passed.
AWV blended with chronic-condition management, single note
Not BillableThe provider refills three chronic medications and adjusts insulin during the AWV, but the documentation is one blended note restating AWV elements. Without a separately identifiable E/M note, only G0439 is billable — the medication management work goes uncompensated. Document the E/M distinctly and append modifier 25 to capture it.
Audit & Compliance
Audit rules & denial defense for G0439.
What a payer reviewer checks on a records request, the failure that triggers each denial, and the documentation that survives it.
11 full calendar months since the last AWV
Denial risk
Frequency denials — and a pattern of early AWV claims invites broader review of the practice's preventive billing
What survives review
Eligibility response with the next-eligible date saved to the chart before the visit is scheduled
Update elements genuinely updated
Denial risk
Cloned notes carrying last year's HRA, medication list, or prevention schedule forward unchanged fail records review
What survives review
Dated changes in the HRA and prevention plan; the patient-facing updated schedule saved as a chart artifact each year
Same-day E/M separately identifiable
Denial risk
Modifier-25 claims on AWV days are audited for E/M notes that merely restate preventive elements
What survives review
A distinct problem-oriented note with its own history, exam, and medical decision-making
No cost-sharing charged for the preventive portion
Denial risk
Charging patients coinsurance for a standalone G0439 creates refund liability and complaints that trigger reviews
What survives review
Front-desk scripts and charge setup that separate the free AWV from any cost-shared same-day services, explained before the visit
FAQ
Common questions about HCPCS G0439.
What is HCPCS G0439?
G0439 is the Medicare billing code for the subsequent Annual Wellness Visit — every AWV after the patient's initial G0438. It updates the health risk assessment and personalized prevention plan, reimburses approximately $138 in 2026, and carries no patient cost-sharing when billed as a standalone preventive visit.
How much does G0439 reimburse in 2026?
Approximately $138 nationally under the 2026 Medicare Physician Fee Schedule ($137.61 before locality adjustment), with no deductible or coinsurance for the patient. The initial AWV, G0438, reimburses approximately $174.
How often can G0439 be billed?
Once per year, provided at least 11 full calendar months have passed since the patient's last AWV (initial or subsequent, with any provider). Scheduling even a few weeks early produces a frequency denial — recall systems should target the month after the anniversary.
What is the difference between G0438 and G0439?
G0438 is the initial Annual Wellness Visit — once per patient lifetime, approximately $174. G0439 is every subsequent annual visit — approximately $138, billable 11 full months after the last AWV. The visit content is similar; the subsequent visit updates the assessments and prevention plan established at the initial one.
Can G0439 be billed with an office visit on the same day?
Yes. If the provider addresses a separately identifiable medical problem during the AWV, bill the E/M code with modifier 25 alongside G0439. The AWV remains free to the patient, but the E/M portion carries normal deductible and coinsurance — practices that explain this before the visit avoid the most common AWV patient complaint.
Does the patient pay anything for G0439?
No — Medicare waives the deductible and coinsurance for the AWV itself. Cost-sharing applies only to additional same-day services: a problem-focused E/M, labs, or diagnostics ordered from the visit. Advance Care Planning (99497) is the exception in the patient's favor: furnished with an AWV, its cost-sharing is waived too.
Related Codes
Other CPT codes.
CCM Initial 20 Minutes
$62.00 • Once per calendar month
RPM Device Supply (16+ Days)
$52.11 • Monthly (per 30-day period)
RPM Clinical Review (First 20 Min)
$51.77 • Once per calendar month
RPM Initial Setup (One-Time)
$21.71 • One-time per episode of care
RPM Clinical Review (Additional 20 Min)
$41.42 • Monthly (per calendar month, add-on to 99457)
Complex CCM Initial 30 Minutes
$86.00 • Once per calendar month
PCM Physician Base (30 Min)
$88.00 • Once per calendar month
BHI Care Management (20 Min)
$53.00 • Once per calendar month
CoCM Initial Month (70 Min)
$163.00 • Once per CoCM episode — the initial month only (subsequent months bill 99493)
CoCM Subsequent Month (60 Min)
$130.00 • Monthly, in each month after the initial 99492 month
CoCM Add-On (Each 30 Min)
$66.00 • As needed, in 30-minute increments, in the same month as 99492 or 99493
Complex CCM Add-On (Each 30 Min)
$63.00 • Monthly, as needed, in addition to the base 99491
CCM Add-On (Each 20 Min)
$50.00 • Up to 2 units per calendar month, in addition to the base 99490
Initial AWV (Once Per Lifetime)
$174.00 • Once per patient lifetime (across all providers)
Sources & Compliance
HCPCS notice. HCPCS Level II codes and their descriptions are maintained by the Centers for Medicare & Medicaid Services (CMS). The plain-language descriptions, billing scenarios, and FAQs on this page are CCN Health’s editorial summary and are not the official CMS descriptors.
Reimbursement. Reimbursement figures shown are CCN Health estimates based on the CMS Medicare Physician Fee Schedule (CY 2026) using published RVU values and the 2026 conversion factor of $33.40. Final payment varies by locality (GPCI), facility status, and payer contract. Fee schedules, relative value units, and conversion factors are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.
Sources. CMS Medicare Physician Fee Schedule, CY 2026 (cms.gov); CMS HCPCS Level II Code Set (cms.gov/hcpcs).
Disclaimer. This page is informational and does not constitute billing, clinical, or legal advice. Verify all codes, modifiers, and reimbursement amounts against your contracted payer agreements and the official CMS publications before billing.