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. Once per lifetime per beneficiary.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
Understand the G0439 frequency limit, Medicare's 11-full-month counting rule, and how to confirm the next eligible Annual Wellness Visit.
Distinguish IPPE, initial AWV and subsequent AWV eligibility, frequency limits and requirements for additional same-day services.
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).
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what G0438 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.