What documentation does G0439 require?

- Updated Health Risk Assessment (HRA), reviewed during the visit. - Updated personal medical and family history, capturing material changes since the last AWV. - Current providers, suppliers, and medication list verified. - Functional ability and safety review: fall-risk screen (Get-Up-and-Go), hearing, vision, ADLs, and IADLs.

What are common G0439 billing pitfalls?

- Billing G0439 within 12 months of the prior AWV. Medicare denies any AWV claim where 365 days have not elapsed since the last G0438 or G0439. Use a calendar tracker; many EHRs flag eligibility prematurely or not at all. - Billing G0439 in the first year of Medicare eligibility. Year 1 uses G0438 (initial AWV) or G0402 (IPPE). G0439 only applies from year 2 onward, and never as the very first AWV. - Performing problem-oriented work without modifier 25 on the E/M. Without the modifier, the problem-oriented work bundles into G0439 and is uncompensated. Modifier 25 belongs on the E/M, never on the AWV.

How much does G0439 pay in 2026?

2026 work RVU for G0439 is 1.92. National Medicare non-facility allowable is approximately $137.61 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

Medicare Wellness · CMS status A

G0439

Ppps, subseq visit

Annual Wellness Visit, subsequent. The annual Medicare preventive benefit billed in year 2 and beyond, after the initial AWV (G0438). CMS 2026 wRVU 1.92. Once per 12 months per beneficiary; do not bill within 365 days of the prior AWV.

Outpatient IM Geri / CCM

Model in calculator →Audit a note

Work RVU

1.92

2026 Medicare pays

$137.61

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 1.92 + Practice 2.07 + Malpractice 0.13 = 4.12 total

Work (your effort)Practice expenseMalpractice

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Subsequent AWV (G0439) Frequency Rules: Avoiding the 12-Month Trap

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.

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AWV vs IPPE vs Subsequent AWV: G0402, G0438, G0439

IPPE (G0402), initial AWV (G0438), and subsequent AWV (G0439) are three different Medicare preventive visits. Here is the decision tree and the timing rules.

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When to use it

G0439 is the annual Medicare AWV for any year after the patient's initial AWV (G0438). Eligibility window: at least 12 months from the most recent AWV.

Full guidance

Medicare denies claims billed earlier than the 365-day mark. The AWV is a structured preventive service, not a problem-oriented encounter; if you also perform problem-oriented E/M work the same day, bill 99213 through 99215 with modifier 25 in addition to G0439 and document the two services separately. Common AWV-day add-ons: G0444 (depression screen), G0537 (ASCVD risk assessment), 99497 with modifier 33 (ACP with cost share waived), G0136 (SDOH risk assessment). The visit can be performed in person or via telehealth depending on payer; Medicare allows AWV via telehealth at POS 02 or POS 10 with modifier 95.

Documentation checklist

✓Updated Health Risk Assessment (HRA), reviewed during the visit.
✓Updated personal medical and family history, capturing material changes since the last AWV.
✓Current providers, suppliers, and medication list verified.
✓Functional ability and safety review: fall-risk screen (Get-Up-and-Go), hearing, vision, ADLs, and IADLs.
✓Cognitive impairment screen using a validated tool (Mini-Cog, MoCA, GPCog) with documented result.
✓Depression screen using PHQ-2 or PHQ-9, with the numeric score documented.
✓Vital signs including height, weight, BMI, and blood pressure.
✓Updated personalized prevention plan with the schedule of recommended preventive services for the next 5 to 10 years, written and shared with the patient.
✓If a problem-oriented E/M is also performed, document the problem-oriented work separately and append modifier 25 to the problem-oriented code (not to G0439).

Common pitfalls

!Billing G0439 within 12 months of the prior AWV. Medicare denies any AWV claim where 365 days have not elapsed since the last G0438 or G0439. Use a calendar tracker; many EHRs flag eligibility prematurely or not at all.
!Billing G0439 in the first year of Medicare eligibility. Year 1 uses G0438 (initial AWV) or G0402 (IPPE). G0439 only applies from year 2 onward, and never as the very first AWV.
!Performing problem-oriented work without modifier 25 on the E/M. Without the modifier, the problem-oriented work bundles into G0439 and is uncompensated. Modifier 25 belongs on the E/M, never on the AWV.
!Forgetting same-day preventive add-ons. G0444, G0537, 99497, and G0136 each have their own billable code and most are not bundled with G0439. Capturing them is straight money on the table.
!Missing the updated personalized prevention plan. Without a documented plan, the AWV is not billable; the plan is the structural deliverable that distinguishes the AWV from a problem-oriented visit.
!Billing G0439 for non-Medicare patients. Commercial payers do not pay G0439. They use 99396 or 99397 (commercial preventive E/M established patient) or their own AWV equivalent codes.

Common modifiers

25 (on the problem-oriented E/M)33 (on same-day 99497 to waive ACP cost share)

Common ICD-10 pairings

Z00.00

Payer notes

Medicare covers G0439 with no patient cost share when billed as a stand-alone AWV. Medicare Advantage plans generally follow Medicare rules but some MA plans use proprietary G-codes for AWV equivalents; verify with each MA plan. Commercial payers do not pay G0439 (Medicare-only); commercial preventive visits use 99396 or 99397 for established patients (or 99386 or 99387 for new patients). Some MA plans pay incentives to providers who complete AWVs at high rates; check your value-based contracts. The 1.92 wRVU plus the same-day add-on stack (G0444, G0537, 99497, G0136) makes AWV-day workflow one of the highest-yield encounters in primary care.