G0438
Ppps, initial visit
Annual Wellness Visit, initial. Medicare Part B preventive benefit covering the first AWV after the patient's Initial Preventive Physical Examination (IPPE) window ends, or the first AWV ever for a Medicare beneficiary who did not have an IPPE. CMS 2026 wRVU 2.60. Once per lifetime per beneficiary.
Medicare denies G0439 if billed within 365 days of the prior AWV. Here is how the frequency rule works and how to time AWVs across your panel.
IPPE (G0402), initial AWV (G0438), and subsequent AWV (G0439) are three different Medicare preventive visits. Here is the decision tree and the timing rules.
Billing guidance for G0438 is locked
- When to use it: the exact clinical situations that support billing G0438
- Documentation checklist: the 9 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get G0438 downcoded or denied
Payer notes
Medicare covers G0438 with no patient cost share. Medicare Advantage plans typically follow Medicare rules but may use proprietary G-codes for their own AWVs; verify with each MA plan. Commercial payers do not pay G0438 (Medicare-only); commercial preventive visits use 99386 or 99387 (new patient) or 99396 or 99397 (established patient).