Guides
Medicare Annual Wellness Visit: G0438, G0439 Billing Guide
The Medicare Annual Wellness Visit is a preventive visit where providers create or update a personalized prevention plan — and identify patients eligible for CCM, RPM, and other chronic care programs. This guide covers G0438, G0439, requirements, and billing.
The Medicare Annual Wellness Visit (AWV) is a yearly preventive visit covered at no cost to Medicare Part B beneficiaries. It uses two HCPCS codes: G0438 for the initial AWV (~$175) and G0439 for subsequent annual visits (~$120). The AWV is not a physical exam — it focuses on health risk assessments, personalized prevention plans, cognitive screenings, and advance care planning. The AWV is strategically important because it is the primary clinical touchpoint where providers identify patients eligible for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other Medicare chronic care programs.
What Is the Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit (AWV) is a yearly preventive visit covered under Medicare Part B that focuses on health risk assessment, prevention planning, and proactive screening — not on diagnosing or treating medical conditions. It was introduced as part of the Affordable Care Act in 2011 to shift Medicare toward preventive care and early intervention rather than reactive treatment after acute episodes.
The AWV is not a physical exam. No hands-on clinical examination is performed during the visit. Instead, the provider reviews the patient's medical and family history, assesses risk factors, screens for cognitive impairment and depression, evaluates fall risk, and creates or updates a personalized prevention plan that includes appropriate screenings, immunizations, and lifestyle counseling.
Medicare uses two HCPCS codes for the AWV:
- G0438 — Initial Annual Wellness Visit, estimated at ~$175
- G0439 — Subsequent Annual Wellness Visit, estimated at ~$120
Both codes are covered at 100% under Medicare Part B. There is no copay, coinsurance, or deductible for the patient. This zero-cost-sharing structure makes the AWV one of the simplest visits to schedule — patients have no financial reason to decline.
For practices managing chronic disease populations, the AWV serves a strategic purpose beyond preventive care reimbursement: it is the primary clinical touchpoint where providers systematically identify patients eligible for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI), and other Medicare chronic care programs. The AWV is where the pipeline begins.
G0438 vs G0439: The Two AWV Codes
G0438: Initial Annual Wellness Visit
Estimated Reimbursement: ~$175
G0438 covers the first Annual Wellness Visit a Medicare beneficiary receives. The patient must have been enrolled in Medicare Part B for at least 12 months before they are eligible for the initial AWV. This code reimburses at a higher rate than the subsequent visit because the initial AWV requires establishing a comprehensive baseline health risk assessment and building the personalized prevention plan from scratch.
Key requirements for G0438:
- Patient must have 12+ months of Part B enrollment
- Comprehensive baseline health risk assessment (HRA) must be established
- Full personalized prevention plan must be created
- Cognitive impairment screening must be performed and documented
- All required AWV elements must be completed and documented
The baseline HRA is the distinguishing factor. It establishes the patient's starting point — current health status, risk factors, chronic conditions, functional abilities, and psychosocial concerns — against which future annual visits will measure changes.
G0439: Subsequent Annual Wellness Visit
Estimated Reimbursement: ~$120
G0439 covers each subsequent Annual Wellness Visit after the initial one. The patient is eligible 12 months after their last AWV (whether it was the initial G0438 or a previous G0439). This visit reviews and updates the existing prevention plan, reassesses risk factors, and screens for new or worsening conditions.
Key requirements for G0439:
- 12+ months since the patient's last AWV
- Updated health risk assessment
- Review and update of the personalized prevention plan
- Cognitive impairment screening
- Updated list of current providers, suppliers, and prescriptions
Because G0439 builds on the existing baseline rather than creating one from scratch, it requires less documentation establishment and reimburses at a lower rate.
AWV Code Comparison Table
| Feature | G0438 (Initial AWV) | G0439 (Subsequent AWV) | G0402 (Welcome to Medicare) |
|---|---|---|---|
| Visit Type | First AWV ever | Annual follow-up AWV | One-time introductory visit |
| Eligibility | 12+ months Part B | 12 months after last AWV | First 12 months of Part B |
| Est. Reimbursement | ~$175 | ~$120 | ~$175 |
| Patient Cost | $0 (100% covered) | $0 (100% covered) | $0 (100% covered) |
| HRA Required | Yes — establish baseline | Yes — update existing | Yes — initial screening |
| Prevention Plan | Create new plan | Update existing plan | Referrals and screening schedule |
| Frequency | Once per lifetime | Every 12 months | Once per lifetime |
| Cognitive Screening | Required | Required | Not required |
All reimbursement figures are estimates based on CMS published fee schedules. Actual rates vary by geographic region and payer.
Important distinction: G0402 (the "Welcome to Medicare" preventive visit) is a separate, one-time visit available within the first 12 months of Part B enrollment. It does not replace the AWV and does not count as the initial AWV. A patient can receive G0402 in their first year and then G0438 after 12 months of enrollment.
What the AWV Includes
A compliant Annual Wellness Visit must include the following elements. Missing any required component creates documentation risk and potential claim vulnerability.
Required Components
Health Risk Assessment (HRA) — A structured questionnaire completed by the patient, ideally before the visit. The HRA collects self-reported information on health status, chronic conditions, functional limitations, psychosocial concerns, behavioral risk factors (smoking, alcohol, physical activity), and fall history. Many practices mail or email the HRA in advance to maximize visit efficiency.
Medical and Family History Review — Update the patient's personal and family medical history, including any new diagnoses, hospitalizations, surgeries, or family health events since the last visit.
Current Provider and Supplier List — Document all healthcare providers and suppliers currently involved in the patient's care, including specialists, home health agencies, pharmacies, and durable medical equipment suppliers.
Biometric Measurements — Height, weight, body mass index (BMI), and blood pressure. These are the only physical measurements taken during the AWV. Note: this is not a physical exam — auscultation, palpation, and other examination techniques are not part of the AWV.
Cognitive Impairment Screening — A structured assessment for signs of cognitive decline. CMS does not mandate a specific tool, but commonly used instruments include the Mini-Cog, Montreal Cognitive Assessment (MoCA), and the General Practitioner Assessment of Cognition (GPCOG). The screening must be documented with the tool used and the result.
Depression Screening — Screen for depression using a validated instrument such as the PHQ-2 or PHQ-9. A positive screen should trigger appropriate follow-up and referral.
Fall Risk Assessment — Evaluate the patient's risk of falling, including review of fall history, gait and balance concerns, medication review for fall-risk-increasing drugs, and home safety assessment.
Functional Ability and Safety Review — Assess activities of daily living (ADLs), hearing and vision status, home safety considerations, and the patient's ability to manage medications and self-care independently.
Personalized Prevention Plan — The centerpiece of the AWV. This plan documents recommended preventive services (screenings, immunizations), risk factors identified, and interventions recommended. For G0438, the plan is created from scratch. For G0439, the existing plan is reviewed and updated.
Advance Care Planning Discussion — While not a required AWV element, advance care planning is a recommended component and can be billed separately using CPT 99497/99498 when performed during the same visit. Discussing advance directives, healthcare proxy designations, and end-of-life preferences during the AWV is a clinical best practice.
AWV vs Physical Exam
This is one of the most common points of confusion — for both patients and clinical staff. The Annual Wellness Visit and a physical examination serve fundamentally different clinical purposes, and understanding the distinction is critical for correct billing.
| Feature | Annual Wellness Visit (G0438/G0439) | Physical Exam (E/M Visit) |
|---|---|---|
| Purpose | Preventive planning and risk assessment | Diagnose and treat medical problems |
| Physical Examination | No hands-on exam (biometrics only) | Full or focused physical examination |
| Diagnostic Testing | Not included | May include labs, imaging, EKG |
| Treatment Decisions | Prevention plan, screenings, referrals | Medication changes, procedures, orders |
| Patient Cost | $0 — 100% Medicare covered | Subject to copay, coinsurance, deductible |
| Frequency | Once per 12 months | As medically necessary |
| Cognitive Screening | Required | Not standard |
| HRA Questionnaire | Required | Not required |
Billing Both on the Same Day
When a patient presents for an AWV but the provider also identifies and addresses a separate, medically necessary problem during the encounter, both the AWV and an Evaluation and Management (E/M) office visit can be billed on the same day. The E/M code (99212-99215) must be appended with modifier 25 to indicate that a significant, separately identifiable E/M service was performed in addition to the preventive visit.
For example: A patient arrives for their subsequent AWV (G0439). During the health risk assessment review, the provider identifies uncontrolled blood pressure and adjusts the patient's medication. The AWV (G0439) is billed for the preventive planning components, and a separate E/M code with modifier 25 is billed for the hypertension management. The patient pays $0 for the AWV and their standard cost-sharing for the E/M service.
This same-day billing capability increases the per-encounter revenue and ensures providers are compensated for all clinical work performed.
Patient Eligibility
G0438 Eligibility (Initial AWV)
- Enrolled in Medicare Part B for at least 12 months
- Has not previously received a G0438
- Note: Receiving the Welcome to Medicare visit (G0402) does not disqualify a patient from G0438
G0439 Eligibility (Subsequent AWV)
- At least 12 months since the last AWV (G0438 or G0439)
- Ongoing Medicare Part B enrollment
Medicare Advantage (Part C) Considerations
Medicare Advantage plans are required to cover all Part B preventive services, including the AWV. However, reimbursement rates and documentation requirements may differ from Original Medicare. Practices should verify AWV coverage and billing procedures with each MA plan.
Common Eligibility Mistakes
- Billing G0438 before 12 months of Part B enrollment — The patient must have been enrolled for a full 12 months before the initial AWV
- Billing G0439 within 12 months of the last AWV — The 12-month interval must elapse between visits
- Confusing G0402 with G0438 — The Welcome to Medicare visit is a separate benefit and does not replace the initial AWV
AWV as the Gateway to Chronic Care Programs
This is the most strategically important aspect of the Annual Wellness Visit for practices running or considering Medicare chronic care programs. The AWV is not just a standalone preventive visit — it is the structured clinical encounter where providers systematically identify patients who qualify for CCM, RPM, BHI, and other recurring revenue programs.
Why the AWV Is the Ideal Screening Touchpoint
During every AWV, the provider reviews the patient's complete chronic condition profile, medication list, functional status, cognitive health, and behavioral health. This comprehensive review — which is required for AWV compliance — also happens to surface exactly the clinical information needed to determine eligibility for chronic care programs:
- CCM eligibility: The medical history review identifies patients with two or more chronic conditions — the foundational requirement for Chronic Care Management
- RPM eligibility: The health risk assessment and condition review reveal patients with conditions amenable to remote device monitoring (hypertension, diabetes, COPD, heart failure, weight management)
- BHI eligibility: The depression screening (PHQ-2/PHQ-9) identifies patients with behavioral health conditions qualifying for Behavioral Health Integration
- Fall risk and monitoring: The fall risk assessment identifies candidates for fall detection and contactless monitoring programs
The AWV consent process also creates a natural opportunity to discuss and obtain patient consent for CCM and RPM enrollment during the same visit.
The Revenue Cascade: From AWV to Recurring Revenue
The AWV generates one-time visit revenue. But its true financial value is the downstream chronic care program enrollment it enables. Here is what the revenue pipeline looks like when AWV is used systematically as a screening and enrollment tool:
| Stage | Service | Estimated Revenue | Frequency |
|---|---|---|---|
| Visit | AWV (G0439) | ~$120 | Annual |
| Same-Day Add | E/M with modifier 25 | ~$75–$150 | As needed |
| Enrollment | CCM (99490 + 99439) | ~$62–$109/month | Monthly recurring |
| Enrollment | RPM (99454 + 99457) | ~$97–$139/month | Monthly recurring |
| Enrollment | BHI (99484) | ~$53/month | Monthly recurring |
| Combined | AWV + CCM + RPM pipeline | ~$159–$248/month | Monthly recurring |
All figures are estimates based on CMS published fee schedules. Actual rates vary by region and payer.
Practice-Level Impact
Consider a practice that performs 200 AWVs per year and uses each visit as a chronic care program screening opportunity:
| Metric | Conservative (30% conversion) | Moderate (40% conversion) | Aggressive (50% conversion) |
|---|---|---|---|
| AWVs Performed | 200 | 200 | 200 |
| AWV Revenue | ~$24,000 | ~$24,000 | ~$24,000 |
| CCM Enrollments | 60 patients | 80 patients | 100 patients |
| CCM Revenue (annual) | ~$44,640 | ~$59,520 | ~$74,400 |
| RPM Enrollments | 40 patients | 55 patients | 70 patients |
| RPM Revenue (annual) | ~$46,560 | ~$64,020 | ~$81,480 |
| Total Pipeline Revenue | ~$115,200 | ~$147,540 | ~$179,880 |
Assumes average CCM revenue of ~$62/patient/month and average RPM revenue of ~$97/patient/month. Estimates based on CMS published fee schedules.
The AWV itself generates ~$24,000 in annual revenue. The downstream CCM and RPM enrollments that flow from those AWVs can generate five to seven times that amount in recurring monthly revenue. This is why the AWV should be treated as a strategic enrollment event, not merely a preventive visit.
Documentation Requirements
Audit-Ready Documentation Checklist
A compliant AWV must have documentation demonstrating that all required elements were completed. Auditors reviewing AWV claims look for:
1. Health Risk Assessment completion — The HRA questionnaire must be documented in the medical record, whether completed by the patient in advance or during the visit. The provider must review the HRA and document their review.
2. Personalized prevention plan — The plan must include recommended screenings and their scheduled dates, immunization status and recommendations, identified risk factors, and recommended interventions. For G0438, the plan must be newly established. For G0439, documentation must show the plan was reviewed and updated.
3. Cognitive screening documentation — The specific tool used (Mini-Cog, MoCA, GPCOG, etc.) must be identified, and the result or clinical impression must be documented. A note stating "cognition appeared normal" without a structured screening tool is insufficient.
4. All required biometrics — Height, weight, BMI, and blood pressure must be recorded.
5. Depression screening — Validated tool (PHQ-2, PHQ-9) with documented result and follow-up plan if positive.
6. Provider and supplier list — Updated list of all providers and suppliers involved in the patient's care.
7. Medical and family history update — Documented review and update since last visit.
Documentation Tips
- Pre-visit HRA workflow: Send the HRA questionnaire to patients before the visit via patient portal or mail. This reduces visit time and ensures thorough completion.
- Template-driven documentation: Use EHR templates that include all required AWV elements as structured fields. This prevents documentation gaps and ensures every required component is addressed.
- Separate documentation for same-day E/M: When billing an E/M visit alongside the AWV, ensure the E/M documentation clearly describes a separately identifiable medical problem — not a reiteration of AWV findings.
Billing Tips and Common Mistakes
Mistake 1: Using G0439 for the Initial Visit
Some practices default to G0439 for all AWVs, missing the higher-reimbursement G0438 for patients receiving their first-ever AWV. The difference is approximately ~$55 per visit. For a practice that misses G0438 on 50 eligible patients, that is an estimated ~$2,750 in missed revenue.
Solution: Flag patients in your scheduling system who have never had a G0438. When a Medicare patient has been enrolled in Part B for 12+ months with no prior AWV on record, bill G0438.
Mistake 2: Confusing the AWV with G0402
G0402 (Welcome to Medicare) is a one-time visit available in the first 12 months of Part B enrollment. It is not an AWV and does not replace G0438. A patient can receive G0402 in year one and G0438 in year two. Billing G0402 after the first 12 months of enrollment, or billing G0438 before 12 months of enrollment, will result in claim denial.
Mistake 3: Not Using Modifier 25 for Same-Day E/M
When a medically necessary E/M service is performed during the same encounter as the AWV, the E/M code must include modifier 25. Without modifier 25, the E/M claim will likely be denied. The E/M service must be separately identifiable — the documentation must clearly show a distinct clinical problem was addressed beyond the AWV components.
Mistake 4: Billing the AWV Within 12 Months
The 12-month interval between AWVs must elapse. Billing G0439 at 11 months since the last AWV will result in denial. Track AWV dates in your scheduling system and flag patients when they become eligible for their next visit.
Mistake 5: Incomplete HRA Documentation
The Health Risk Assessment is a foundational AWV element. If the HRA is missing from the medical record, the entire AWV claim is vulnerable. Even if the provider performed all other elements, auditors may deny the claim for missing HRA documentation.
Solution: Build the HRA into your pre-visit workflow and make its completion a hard stop before the AWV can be billed.
Mistake 6: Applying Patient Cost-Sharing
The AWV is covered at 100% under Medicare Part B with no copay, coinsurance, or deductible. Collecting cost-sharing for an AWV is a billing error. If an E/M service is billed on the same day, cost-sharing applies only to the E/M component.
Revenue Modeling
Per-Visit Reimbursement
| Visit Type | HCPCS Code | Estimated Reimbursement | Patient Cost |
|---|---|---|---|
| Initial AWV | G0438 | ~$175 | $0 |
| Subsequent AWV | G0439 | ~$120 | $0 |
| Welcome to Medicare | G0402 | ~$175 | $0 |
| Same-day E/M (mod 25) | 99213-99215 | ~$75–$150 | Standard cost-sharing |
Estimates based on CMS published fee schedules. Actual rates vary by geographic region and payer.
Practice-Level AWV Revenue
| AWVs Per Year | G0438 Mix (20%) | G0439 Mix (80%) | Estimated AWV Revenue | With 50% Same-Day E/M (~$100 avg) |
|---|---|---|---|---|
| 100 | 20 × ~$175 | 80 × ~$120 | ~$13,100 | ~$18,100 |
| 200 | 40 × ~$175 | 160 × ~$120 | ~$26,200 | ~$36,200 |
| 500 | 100 × ~$175 | 400 × ~$120 | ~$65,500 | ~$90,500 |
AWV + Downstream Chronic Care Revenue
The full financial impact of an AWV program includes the chronic care enrollments it generates. Assuming a 35% CCM conversion rate and 25% RPM conversion rate from AWVs:
| Annual AWVs | AWV Revenue | CCM Enrollments (35%) | CCM Annual Revenue | RPM Enrollments (25%) | RPM Annual Revenue | Total Pipeline |
|---|---|---|---|---|---|---|
| 100 | ~$13,100 | 35 | ~$26,040 | 25 | ~$29,100 | ~$68,240 |
| 200 | ~$26,200 | 70 | ~$52,080 | 50 | ~$58,200 | ~$136,480 |
| 500 | ~$65,500 | 175 | ~$130,200 | 125 | ~$145,500 | ~$341,200 |
Assumes average CCM revenue of ~$62/patient/month and average RPM revenue of ~$97/patient/month. All figures are estimates based on CMS published fee schedules.
These projections illustrate why the AWV should be viewed not as a ~$120 visit but as the entry point to a revenue pipeline worth five to seven times the visit itself. Practices that build systematic AWV-to-chronic-care enrollment workflows capture significantly more value from every patient encounter.
How CCN Health Connects AWV to Chronic Care Enrollment
CCN Health's platform is designed to support the downstream programs that AWVs identify patients for. When a provider uses the AWV to screen for CCM and RPM eligibility, CCN Health provides the infrastructure to enroll, monitor, and bill those patients from the same day forward.
For practices identifying RPM candidates during AWVs, CCN Health handles device provisioning, patient onboarding, daily data transmission, clinical monitoring, and billing support — transforming the AWV screening into active RPM enrollment within days. For CCM-eligible patients, CCN Health's care coordination tools support care plan documentation, time tracking, and compliant billing.
The AWV is the clinical front door. CCN Health is the operational infrastructure that turns that visit into recurring revenue.
Learn how CCN Health helps identify RPM and CCM candidates →
Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or billing advice. Reimbursement amounts are estimates based on CMS published fee schedules and may vary by region, payer, and clinical circumstances. Always consult qualified healthcare and billing professionals for guidance specific to your practice.
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Why It Matters
Key Benefits
See how this approach drives measurable improvements across your organization.
Zero Patient Cost
Medicare covers the AWV at 100% — no copay, coinsurance, or deductible — making it one of the easiest visits to schedule because patients have no financial barrier.
CCM/RPM Gateway
The AWV is the primary clinical touchpoint for identifying patients eligible for CCM, RPM, BHI, and other chronic care programs — the starting point for recurring revenue streams.
Preventive Care Revenue
At ~$120–$175 per visit, the AWV itself generates meaningful revenue — and when combined with same-day E/M billing (modifier 25), the encounter value increases.
Patient Relationship Builder
The AWV provides structured face-time with patients to discuss health goals, review chronic conditions, and build the trust that supports program enrollment.
Quality Measure Alignment
AWV components (cognitive screening, fall risk assessment, preventive care planning) align with Medicare quality reporting measures that affect practice reimbursement.
Chronic Care Identification
The health risk assessment and medical history review systematically surface chronic conditions — identifying patients who may not yet be managed for CCM or RPM.
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Common Questions
Frequently Asked Questions
Get answers to the most common questions about this topic.
The Medicare Annual Wellness Visit (AWV) is a yearly preventive visit where a healthcare provider reviews the patient's health status, updates their personalized prevention plan, screens for cognitive impairment, assesses fall risk and functional abilities, and creates or updates a list of current providers and prescriptions. It is not a physical exam — no hands-on examination is performed unless a separate evaluation and management service is also provided. Medicare Part B covers the AWV at 100% with no copay, coinsurance, or deductible for the patient.
G0438 is the initial AWV — the first Annual Wellness Visit a Medicare beneficiary receives after enrolling in Part B (eligible after 12 months of enrollment). G0439 is the subsequent AWV — each annual visit after the initial one (eligible 12 months after the last AWV). G0438 reimburses at a higher rate (~$175) because the initial visit requires establishing the baseline health risk assessment and prevention plan from scratch. G0439 (~$120) covers the annual review and update of the existing plan.
The Annual Wellness Visit is a preventive planning visit — it does not include a physical examination, diagnostic tests, or treatment of medical conditions. A physical exam involves hands-on examination, vital signs, auscultation, and potentially diagnostic workup. If a patient needs both, the provider can bill the AWV (G0438 or G0439) plus an E/M office visit code with modifier 25, provided the E/M service is separately identifiable and medically necessary.
Yes. The AWV is a preventive visit that does not conflict with chronic care management (CCM) or remote patient monitoring (RPM) billing. In fact, the AWV is often the clinical encounter where providers identify patients who qualify for CCM and RPM, perform enrollment consent, and establish care plans. A patient can have an AWV and begin CCM or RPM services in the same calendar month.
A compliant AWV must include: a health risk assessment questionnaire (completed by the patient in advance or during the visit), review and update of the patient's medical and family history, review of current providers and suppliers, measurement of height, weight, BMI, and blood pressure, detection of cognitive impairment, update of the personalized prevention plan with appropriate screenings and immunizations, and a list of risk factors with recommended interventions. For G0438 (initial visit), a comprehensive baseline health risk assessment must also be established.
Medicare beneficiaries can receive one AWV per 12-month period. The initial AWV (G0438) is available once — after the beneficiary has been enrolled in Part B for at least 12 months. After the initial AWV, the patient is eligible for a subsequent AWV (G0439) every 12 months. Note: the 'Welcome to Medicare' preventive visit (G0402) is a separate, one-time visit available within the first 12 months of Part B enrollment — it does not replace the AWV.
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