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Annual wellness visit CPT codes: G0438, G0439 and 2026 payment
Which AWV code to bill, who qualifies, what each pays in 2026, and what can share the claim.
Short answer: G0439 is the Medicare HCPCS code for a subsequent annual wellness visit, including a personalized prevention plan. G0438 identifies the first AWV. G0402 identifies the one-time Welcome to Medicare visit; your practice selects the code from the patient’s Medicare visit history and the service actually furnished.
G0439 reports a subsequent annual wellness visit, rather than the patient’s first visit to your office. The distinction depends on the Medicare wellness benefit already used, including visits furnished elsewhere.
Although people search for an annual wellness visit CPT code, these wellness codes are HCPCS codes. For your scheduler and billing team, the useful questions are which benefit applies, when it is available, what the practitioner documents and whether another service is separately reportable.
Choose the wellness code from the benefit history
First AWV: Use the initial wellness benefit when appropriate, even if the patient has been established in your practice for years.
Subsequent AWV: Use the subsequent wellness benefit after a prior AWV, subject to the frequency rule.
Separate service: An additional E/M charge requires a significant, separately identifiable, medically necessary service.
G0439 versus the first wellness visit and Welcome to Medicare
CMS separates the initial preventive physical examination from the annual wellness benefit. The IPPE is available once during the first year after Part B coverage begins. It does not turn a later AWV into a subsequent AWV; the practice still checks whether the patient has previously received an AWV.
| Code | Medicare service | Selection question |
|---|---|---|
| G0402 | Initial preventive physical examination, or IPPE | Is the patient within the first 12 months of Part B coverage and has the lifetime benefit been used? |
| G0438 | Initial annual wellness visit with personalized prevention plan | Is this the patient’s first AWV, and is the benefit available? |
| G0439 | Subsequent annual wellness visit with personalized prevention plan | Has the patient already received an AWV, and is another covered AWV due? |
CMS permits only one AWV in a 12-month period and bars an AWV within 12 months of an IPPE. A new calendar year is not sufficient evidence that the benefit is available. Check the relevant prior service dates before the appointment is described to the patient as covered.
A patient who changes practices does not restart the initial wellness benefit. Your office’s new-patient status answers a different question from Medicare’s initial-versus-subsequent wellness distinction. Ask about prior services elsewhere and verify the available benefit through your normal eligibility process.
If prior history is incomplete, resolve it before choosing the initial code. A patient may remember a yearly appointment as a physical even when the prior practice billed a wellness service. Use the documented benefit history to settle the coding question rather than relying on the appointment name.
What G0439 requires the team to update
A subsequent AWV updates the health risk assessment and personalized prevention work. CMS lists medical and family history, the provider and supplier list, appropriate measurements, cognitive-impairment detection, the written screening schedule and the risk-factor list among its components. The record should show the update performed for this encounter.
- Review the health risk assessment and the patient’s self-reported information.
- Update medical history, medications and the clinicians involved in the patient’s care.
- Update the written screening schedule, risk factors and personalized advice or referrals.
The HRA includes more than a diagnosis list. CMS identifies psychosocial risks, behavioral risks, daily activities and instrumental activities such as transportation or medication management. Make room for those answers in the visit record rather than treating the HRA as an intake checkbox.
The initial AWV establishes information that subsequent visits update. That difference helps the team prepare an appropriate note, but it does not justify copying the prior note without review. A practical template should make changes and current findings easy for the billing practitioner to find.
Use the Medicare annual wellness visit checklist for the full visit preparation workflow. This code guide focuses on selecting and supporting the claim, rather than replacing the component-by-component checklist.
A practical G0439 scheduling and billing process
Step 1: Check the benefit before scheduling
Identify the Part B start date and prior IPPE and AWV history. Confirm whether the visit should establish or update the prevention plan. Tell the patient what the appointment covers so a separate medical concern is identified rather than hidden inside a wellness label.
Step 2: Gather the information the visit needs
Ask the patient to bring medical records, family history, a current medication and supplement list, and the clinicians involved in their care. CMS expressly recommends these preparation materials. A complete list helps the team update the record during the encounter instead of reconstructing it afterward.
Step 3: Match the note to the service
Confirm that the record supports the relevant initial or subsequent components. CMS allows a diagnosis consistent with the examination and does not mandate a specific AWV diagnosis code. Choose the diagnosis from the actual documented visit, rather than assuming a single universal code is compulsory.
Step 4: Review any additional charges separately
Identify any significant, separately identifiable, medically necessary E/M service. If its requirements are met, CMS instructs the practice to report that E/M code with modifier 25. The modifier belongs on the separate E/M service, not as a way to make routine wellness components separately payable.
A useful final review asks whether the note would still support the additional medical service after the AWV components were set aside. That is a practical review question, not a substitute for CMS requirements. Your practitioner and billing team should resolve uncertain service combinations with the MAC before submitting the claim.
Who can furnish the wellness visit
CMS covers an AWV furnished by a physician or a qualified non-physician practitioner, including a physician assistant, nurse practitioner or certified clinical nurse specialist. CMS also permits a medical professional or team of medical professionals directly supervised by a physician. Do not assume the general-supervision rule for monthly CCM automatically applies to the AWV.
Your practice should assign roles before the patient arrives: who gathers the HRA, who reviews the findings and who completes the documented service. Those operational assignments must fit the applicable CMS category and supervision rule. A familiar staff title by itself does not answer the billing question.
The screening schedule and prevention recommendations need to be identifiable in the record. Keep preventive planning distinct from active management of illness when an E/M service is also considered. That distinction helps the reviewer understand the service rather than relying on a combined appointment label.
Optional ACP and the separate CCM handoff
Advance care planning can be an optional part of the AWV at the patient’s discretion. Its time-based codes have their own requirements; the advance care planning guide explains them. The ACP waiver requires the same day and provider, the same AWV claim and modifier 33, and depends on a covered AWV.
An AWV may also serve as a CCM initiating visit when the patient is new or has not seen the billing practitioner during the previous year. The billing practitioner must discuss CCM at that visit for it to qualify. The AWV does not establish CCM consent merely because the patient attended.
Documented CCM consent is a separate requirement. Your team should distinguish the wellness visit note, the CCM discussion and the consent record when referring a patient for between-visit services. This keeps a preventive visit from being treated as automatic monthly care-management enrollment.
The care-management program then follows its own patient eligibility, care-plan and service rules. The wellness benefit and the monthly program are different billing decisions, even when the same encounter starts the conversation. Avoid setting up a recurring charge solely because a wellness visit took place.
Wellness coding mistakes worth catching
Review these before releasing the claim
New to your office: That does not establish that this is the patient’s first Medicare AWV.
January appointment: The new year does not replace the 12-month benefit check.
Automatic modifier: A separate E/M service needs its own medically necessary work and documentation.
Automatic enrollment: The AWV and CCM consent are separate requirements.
Care management after the wellness appointment
Companian does not offer annual wellness visits. Practices planning services between appointments can review care management for primary care practices for chronic care management codes 99490 and 99439 or principal care management codes 99426 and 99427.
For supported care-management workflows, Companian describes the handoff this way: Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license. Which team members’ time counts toward each code is set in your services agreement.
Key takeaways
- G0439 identifies a subsequent Medicare AWV.
- G0438 identifies the initial AWV rather than a new visit to your practice.
- G0402 identifies the one-time IPPE within the first year of Part B coverage.
- A separate E/M charge requires a significant, separately identifiable, medically necessary service.
- An AWV can initiate CCM when the initiating-visit requirements are met, but consent is separate.
Frequently asked questions about g0439
Does a new patient to our practice automatically qualify for G0438?
No. The initial-versus-subsequent AWV distinction follows the patient’s prior Medicare wellness history, so your practice should check services furnished elsewhere.
Can our office repeat G0439 when January begins?
The calendar change alone is insufficient. CMS limits AWV billing to once in a 12-month period and also restricts AWVs after an IPPE.
Which code is used for the Welcome to Medicare visit?
G0402 identifies the IPPE. CMS covers one lifetime IPPE when furnished within the first 12 months after Part B coverage starts.
Does Medicare mandate one diagnosis code for every AWV claim?
No. CMS requires a diagnosis on the claim but permits a code consistent with the patient’s examination.
Where does modifier 25 belong when an AWV includes separate illness care?
CMS instructs the practice to report the additional E/M code with modifier 25. The additional service must be significant, separately identifiable and medically necessary.
Does attending a wellness visit establish consent for monthly CCM?
No. CCM consent and the initiating visit are separate requirements, and the patient’s decision must be documented.
Companian does not offer AWVs; physician practices distinguish Medicare Part B wellness codes G0438 and G0439 from supported chronic care management codes 99490 and 99439. Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.
Read more: Annual wellness visit preparation · Advance care planning codes
Turn wellness visits into ongoing care
See how Companian runs care management for your primary care practice. Your practice bills Medicare under its own NPI.
Rates & disclosures
National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.
Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.
Sources:
- CMS, Annual Wellness Visit provider page
- Medicare.gov, Yearly “Wellness” visits
- CMS MLN909289, Advance Care Planning
- CMS MLN Matters MM13473, G2211
- CMS MLN909188, Chronic Care Management Services
- CMS 2026 Physician Fee Schedule relative value files (RVU26D)
Disclosures
This guide summarizes CMS information for physician practices. It is not legal or billing advice.