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.
When to use it
Use G0438 for a Medicare beneficiary's first AWV. Eligibility window: the patient must be past 12 months from their IPPE eligibility, OR has been on Medicare more than 12 months.
Full guidance
Once-per-lifetime; year two and onward use G0439 (subsequent AWV). The AWV is a structured preventive service, not a problem-oriented visit. If you also performed problem-oriented E/M work, bill 99213 through 99215 with modifier 25 in addition to G0438 and document the two services separately.
Documentation checklist
- ✓Health Risk Assessment (HRA) completed and reviewed.
- ✓Personal medical and family history reviewed and updated.
- ✓List of current providers, suppliers, and medications.
- ✓Functional ability and safety review (Get-Up-and-Go test, fall risk, hearing).
- ✓Cognitive impairment screening using a validated tool (Mini-Cog, MoCA, GPCog).
- ✓Depression screening using a validated tool (PHQ-2 or PHQ-9).
- ✓Vital signs including height, weight, BMI, and blood pressure.
- ✓Personalized prevention plan written and shared with the patient; should include a schedule of recommended preventive services for the next 5 to 10 years.
- ✓Social determinants of health screening: G0136 may be billed separately if a validated SDOH tool is administered.
Common pitfalls
- !Billing G0438 for a patient who has already had a Medicare AWV. The correct code from year 2 onward is G0439 (subsequent AWV).
- !Performing a problem-oriented E/M on the same day without modifier 25 on the E/M. The problem-oriented work is uncompensated without the modifier.
- !Forgetting same-day add-ons: G0444 (depression screen as a separate billable preventive code), G0537 (ASCVD risk assessment), 99497 (ACP, especially with modifier 33 to waive cost share), G0136 (SDOH).
- !Missing the personalized prevention plan. Without the written plan, the AWV is not billable; documentation must show the plan was created and discussed.
- !Billing G0438 for a non-Medicare patient. Commercial payers and Medicare Advantage may use 99386 or 99387 (commercial preventive E/M) or follow their own AWV rules.
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).