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

Three different visits, one decision

The IPPE, or Initial Preventive Physical Examination, is the "Welcome to Medicare" visit (G0402). It is a one-time visit available only during the first 12 months of Medicare Part B enrollment.

The initial AWV (G0438) is the patient's first Annual Wellness Visit. It is once per lifetime and is not the same service as the IPPE.

The subsequent AWV (G0439) is every AWV after the first one, once per year thereafter.

A patient gets at most one IPPE ever, at most one G0438 ever, and then G0439 every year for the rest of their Medicare life.

The decision tree

Ask three questions in order.

• Is the patient within the first 12 months of Part B enrollment and has never had an IPPE? Bill the IPPE (G0402).
• Has the patient had Medicare more than 12 months (or had an IPPE more than 12 months ago) and never had any AWV? Bill the initial AWV (G0438).
• Has the patient already had at least one AWV? Bill the subsequent AWV (G0439), if at least 365 days have elapsed since the last AWV.

An IPPE is not a prerequisite for an AWV

A common misconception is that the patient must have had an IPPE before you can bill an AWV. That is false. Many patients never have an IPPE because they did not see a clinician in their first 12 months of Part B.

If there was no IPPE, the patient's first AWV is still G0438 (the initial AWV), billable once the patient has had Part B for more than 12 months. The IPPE is simply skipped.

What the IPPE (G0402) requires

The IPPE is a structured preventive visit, not a head-to-toe physical. Required elements include the following.

• Review of medical and social history, including risk factors.
• Review of potential depression risk factors and a screen.
• Review of functional ability and safety (hearing, falls, home safety, ADLs).
• Limited exam: height, weight, BMI, blood pressure, and visual acuity screen.
• End-of-life planning discussion when the patient agrees.
• Education, counseling, and referral, plus a written checklist of preventive services and a screening schedule.
• An optional screening EKG referral, reported separately with G0403, G0404, or G0405.

What the AWV (G0438 and G0439) requires

The AWV is a planning visit centered on a Health Risk Assessment. There is no required physical exam beyond vitals. The initial AWV (G0438) establishes the baseline; the subsequent AWV (G0439) updates it.

• Administer or review a Health Risk Assessment (96160 is separately billable).
• Establish or update medical and family history and the list of current providers and suppliers.
• Vitals including height, weight, BMI, and blood pressure.
• Detect cognitive impairment, with a structured assessment.
• Screen for depression and review functional ability and safety.
• Establish or update a written 5 to 10 year screening schedule and a list of risk factors.
• Provide personalized health advice and referrals to health education or preventive counseling.

The timing traps that cause denials

Three timing mistakes account for most preventive-visit denials.

• Billing the IPPE after the 12-month Part B window closes. It denies; there is no grace period. After that window the correct first preventive visit is G0438.
• Billing G0438 for a patient who already had an AWV. G0438 is once per lifetime. Check claims history or prior records first.
• Billing G0439 too early. Medicare requires at least 365 days since the prior AWV, counted by date, not calendar year. See the dedicated G0439 frequency guide for the date math.

Patient cost-share

When billed correctly, the IPPE and both AWVs have no patient deductible and no coinsurance. They are preventive.

Two caveats. The screening EKG associated with an IPPE (G0403 to G0405) is a separate service and can carry cost-share. And if problem-oriented work is done the same day and billed with a separate E/M and modifier 25, that E/M carries normal cost-share.

Same-day problem work and the add-on stack

Any of these visits can be paired with a problem-oriented E/M (99213 to 99215) when the patient also has problems that need management. The E/M, not the preventive visit, carries modifier 25.

On an AWV day specifically, the add-on stack (depression screen G0444, ASCVD risk G0537, advance care planning 99497 with modifier 33, SDOH risk G0136, HRA 96160) can roughly double the value of the visit. The subsequent-AWV guide details that stack.

Commercial equivalents

G0402, G0438, and G0439 are Medicare codes. Commercial preventive medicine visits use 99381 to 99387 (new patient, by age) and 99391 to 99397 (established patient, by age). Some Medicare Advantage plans accept the G codes; others use proprietary preventive codes. Verify per plan.

Bottom line

First 12 months of Part B with no prior IPPE: bill G0402. First-ever AWV after that: bill G0438. Every AWV after the first: bill G0439, at least 365 days apart. An IPPE is never required before an AWV, and only one visit in a patient's Medicare life is ever G0438.