Annual Wellness Visit is a service designed by Medicare to help develop or update a patient’s personalized prevention plan and to perform a health risk assessment (HRA).
The AWV focuses on prevention and identifying health risks rather than providing a comprehensive head-to-toe physical examination. According to CMS, it states that AWV includes a health risk assessment and components such as reviewing health information, assessing risk, and developing or updating a personalized prevention plan.
What happens during an AWV?
An Annual Wellness Visit (AWV) is a once-a-year appointment backed by Medicare which centres on either creating a new or updating an individual’s prevention plan. It is not a physical examination involving hands-on care and does not involve any laboratory tests or treatment of chronic diseases.
Components of an AWV
- Health Risk Assessment (HRA)
- Medical & Family History
- Medication Review
- Routine Measurements
- Cognitive & Mental Screenings
- Functional & Safety Checks
- Personalized Schedule
- Optional Discussions
What Is the Annual Wellness Visit CPT Code?
These codes are commonly known as CPT codes or Medicare Wellness visit CPT codes, but these are HCPCS Level II codes, rather than standard five-digit CPT codes.
| Code | Service | When Used |
| G0438 | Initial Annual Wellness Visit | Patient’s first covered AWV |
| G0439 | Annual Wellness Visit, subsequent | Later covered AWVs |
| G0402 | Initial Preventive Physical Examination | First 12 months of Medicare Part B eligibility |
The correct Annual Wellness Visit CPT Code depends primarily on the patient’s Medicare history and whether the patient is receiving an initial or subsequent AWV.
G0438 CPT Code
G0438 is the initial Annual Wellness Visit code for Medicare that includes a personalized prevention plan of service and is used for the initial visit.
A common misconception for cpt code for annual wellness visit is that “initial” means the patient’s first visit with a particular physician or practice. It does not simply mean the first time the patient has ever visited that practice.
The patient’s Medicare preventive-service history determines whether G0438 is appropriate.
A provider should verify whether the patient has already received an IPPE or previous AWV before submitting G0438.
When is G0438 used?
G0438 is generally used when the patient is eligible for an initial covered AWV and has not previously received an AWV that would make G0438 inappropriate.
According to CMS these codes G0438 or G0439 only be billed once in a 12-month period, and an AWV should not be billed within 12 months of G0402 for the same patient.
G0439 CPT Code: Subsequent Annual Wellness Visit
Once a patient has completed the initial AWV and meets the applicable Medicare timing requirements, subsequent AWVs are generally reported with G0439.
The Annual Wellness Visit CPT Code G0439 is not a code that should be used simply because a patient returns to the office one year later. The provider must verify the patient’s Medicare preventive-service history and the 12-month frequency limitation.
Understanding the difference between G0438 and G0439
The difference between G0438 and G0439 is primarily the patient’s status within the Medicare AWV benefit.
| Feature | G0438 | G0439 |
| AWV type | Initial | Subsequent |
| Medicare AWV sequence | First covered AWV | Later covered AWV |
| Personalized prevention plan | Included | Included |
| 12-month frequency limitation | Yes | Yes |
| Same as a physical exam? | No | No |
CMS confirms that G0438 is for the first AWV and G0439 is for subsequent AWVs. Neither should be reported within 12 months of G0402 for the same patient.
Let’s understand it with an Example:
Suppose a patient receives an eligible initial AWV and the provider bills G0438.
When the patient becomes eligible for another AWV after the 12-month period, the provider would generally use G0439, assuming all billing requirements are met.
The sequence is therefore:
Eligible initial AWV → G0438 → later eligible AWV → G0439
G0402 CPT Code Description: Initial Preventive Physical Examination
G0402 CPT Code Description
HCPCS code G0402 represents the Initial Preventive Physical Examination (IPPE), commonly known as the “Welcome to Medicare” visit. It is a face-to-face, once-in-a-lifetime benefit available exclusively during a patient’s first 12 months of Medicare Part B enrollment.
G0402 vs G0438 vs G0439
The easiest way to understand these codes is to look at the Medicare preventive-service timeline.
G0402
Used for the Initial Preventive Physical Examination during the first 12 months after the patient’s Medicare Part B coverage begins, subject to applicable eligibility requirements.
G0438
Used for the initial Annual Wellness Visit when the patient is eligible for the AWV benefit.
G0439 CPT code description
Used for subsequent Annual Wellness Visits. CMS distinguishes the IPPE from the AWV and gives each service a different HCPCS code.
Annual Wellness Visit vs. Physical Examination
One of the most important billing distinctions is the difference between an AWV and a routine physical.
A Medicare AWV is designed around prevention, health risk assessment, and personalized prevention planning.
A routine physical examination is a different service.
CMS describes a routine physical exam as an examination performed without a relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury. Medicare does not cover a routine physical examination as a Medicare benefit.
Therefore, a provider should not automatically use a Medicare AWV code simply because the patient asks for a “yearly physical.”
Physical examination CPT code
For commercial insurance or other non-Medicare billing situations, preventive medicine services may be reported using CPT codes in the 99381–99397 range, depending on factors such as whether the patient is new or established and the patient’s age.
For example, 99397 is used for a comprehensive preventive medicine evaluation and management service for an established patient age 65 or older.
However, Medicare has specific rules for its covered IPPE and AWV benefits. CMS instructs providers not to bill CPT 99381–99397 for Medicare services covered by G0402, G0438, and G0439. This distinction is essential when deciding which Annual Wellness Visit CPT Code applies.
Annual Wellness Visit CPT Code for Commercial Insurance
The phrase “annual wellness visit CPT code for commercial” can be misleading because commercial insurers do not all follow the Medicare AWV coding structure.
Medicare uses G0438 and G0439 for its AWV benefit. Commercial insurance plans may instead use preventive medicine CPT codes such as 99381–99397, depending on the patient’s age, new/established status, plan rules, and the service performed.
Therefore, providers should verify the individual commercial payer’s coding and coverage policy before submitting a claim.
There is no single universal Annual Wellness Visit CPT Code for commercial insurance that applies to every private payer.
Commonly considered ICD-10 code for Annual Wellness Visit
Codes in the Z00 category relate to encounters for general examinations.
For example:
- Z00.00 — Encounter for general adult medical examination without abnormal findings
- Z00.01 — Encounter for general adult medical examination with abnormal findings
CMS’s ICD-10-CM materials identify these as general adult examination codes. However, providers should not assume that Z00.00 or Z00.01 is automatically required for every AWV. CMS specifically states that no particular diagnosis code is mandated for the AWV. The appropriate annual wellness visit ICD-10 code should reflect the actual encounter and applicable coding guidelines.
What Is Not Automatically Included in an AWV?
An AWV is not a comprehensive physical exam. If a patient also presents with a separate medical problem, the provider may bill an additional E/M service when it is medically necessary and separately identifiable. In that case, modifier 25 is appended to the E/M code.
Simply performing extra work during an AWV does not automatically justify a separate E/M charge. The documentation must support the additional service.
Can You Bill an E/M Service With an AWV?
Yes, Medicare allows a separate E/M service to be given on the same day if the patient has a medical problem which requires a significant, separately identifiable, and medically necessary evaluation beyond that provided in the AWV; the additional E/M service is then reported using modifier 25.
How Often Can Medicare Pay for an AWV?
According to CMS, providers can bill G0438 or G0439 only once in a 12-month period. CMS also states that G0438 or G0439 should not be billed within 12 months of G0402 for the same patient. This makes eligibility verification an important part of the billing workflow.
Before submitting the Annual Wellness Visit CPT Code, billing staff should verify:
- The patient’s eligibility for Medicare Part B.
- Whether the patient is in the first 12 months of Part B.
- If the patient had previously been given G0402.
- If the patient had received G0438 or G0439 in the past 12 months.
- Which AWV code is appropriate based on the patient’s history?
Can an AWV Be Provided Through Telehealth?
Yes, G0438 and G0439 can be paid when AWV is provided through telehealth. This is particularly relevant for practices building hybrid preventive and chronic-care workflows.
An AWV itself should still meet the applicable Medicare requirements regardless of whether it is furnished in person or through an eligible telehealth modality.
Common Annual Wellness Visit Billing Mistakes
These are the mistakes that should not be overlooked in case of CPT code for annual physical visit.
1. Using G0438 for every first visit
If the patient has a first visit, it does not mean that it is a G0438 encounter. The provider has to make sure that the patient is eligible for an initial AWV according to Medicare requirements and prior history.
2. Confusing G0402 with G0438
G0402 is the Initial Preventive Physical Examination, not the AWV. G0438 represents the initial AWV.
3. Treating an AWV as a routine physical
Medicare distinguishes the AWV from a routine physical examination. The two services have different purposes and billing rules.
4. Using G0439 too early
G0439 cannot simply be billed because 12 calendar months have not yet passed since another appointment. The applicable Medicare 12-month frequency requirements must be satisfied.
5. Automatically assigning one ICD-10 code
CMS does not require one specific diagnosis code for an AWV. The reported diagnosis should be consistent with the encounter.
6. Billing 99397 to Medicare for an AWV
Medicare’s covered AWV benefit uses G0438 or G0439. CMS specifically instructs providers not to use CPT 99381–99397 to bill Medicare for services covered by G0402, G0438, and G0439.
How AWVs Fit Into Ongoing Chronic Care
An AWV is primarily a preventive service, but it can identify patients who need ongoing management for chronic conditions. For example, the AWV may identify that a patient needs continued support for conditions such as hypertension, diabetes, COPD, or other chronic illnesses.
That does not mean an AWV automatically qualifies the patient for Chronic Care Management (CCM) or Remote Patient Monitoring (RPM). Those programs have their own eligibility and billing requirements. You can learn more about Chronic Care Management services or review its CCM CPT codes and billing guide for information about ongoing chronic-care workflows.
Annual Wellness Visit vs. Chronic Care Management
These services address different aspects of patient care.
| Feature | Annual Wellness Visit | Chronic Care Management |
| Primary purpose | Prevention and risk assessment | Ongoing chronic-condition management |
| Frequency | Generally once every 12 months under Medicare | Monthly service structure when requirements are met |
| Main AWV codes | G0438, G0439 | Examples include 99490, 99439, 99491 |
| Focus | Prevention plan and health risks | Care coordination and chronic disease management |
| Requires AWV eligibility? | Yes | No; separate CCM eligibility requirements apply |
MediRemote describes CCM as a program supporting patients with multiple long-term chronic conditions through ongoing care coordination and patient support.
An AWV can therefore serve as one point in a broader patient-care strategy, but providers should code each service according to the actual service performed and the applicable payer rules.
FAQs
What is the CPT code for an Annual Wellness Visit?
For Medicare, the primary Annual Wellness Visit CPT Code is G0438 for the initial AWV and G0439 for subsequent AWVs. Technically, these are HCPCS Level II codes.
What is G0438?
G0438 is the Medicare code for an initial annual wellness visit that includes a personalized prevention plan of service.
What is G0439?
The Medicare code G0439 is that which is used for a subsequent annual wellness visit when a personalized prevention plan is provided as part of the service.
What is G0402?
The Initial Preventive Physical Examination, also known as the ‘Welcome to Medicare’ visit, is a service that differs from the annual wellness visit.
What is the ICD-10 code for an Annual Wellness Visit?
The ICD-10-CM diagnosis code does not exist. CMS mandates that a diagnosis code be used; it allows the provider to choose a diagnosis code that is in accordance with the patient’s examination.
Strengthen Your Medicare AWV Program With MediRemote
Mediremote is a service provider that helps private healthcare practices streamline their remote patient monitoring and chronic workflows. With the help of Mediremote, practices can identify patients who can benefit from monitoring and ongoing care,
Practices considering remote monitoring can also review RPM billing codes to understand how remote monitoring services differ from preventive AWV billing.