Annual Wellness Visit billing cheat sheet (2026)
The Medicare Annual Wellness Visit is structurally a preventive service, but the visit day captures meaningful additional wRVU through the same-day add-on stack. Most practices under-bill G0537 and 99497 specifically. This is the full stack in one card: code, wRVU, frequency, and the one-line documentation hook that makes each billable.
Core AWV codes
| Code | Service | wRVU | Frequency | Documentation hook |
|---|---|---|---|---|
| G0402 | IPPE (Welcome to Medicare) | 2.43 | Once per lifetime, within 12 months of Part B enrollment | Written prevention plan + end-of-life planning offered |
| G0438 | Initial AWV | 2.60 | Once per lifetime, after the IPPE window | Health risk assessment + personalized prevention plan |
| G0439 | Subsequent AWV | 1.92 | Once every 365 days after the initial AWV | Updated HRA + updated prevention plan |
Same-day add-on stack
| Code | Service | wRVU | Frequency | Documentation hook |
|---|---|---|---|---|
| G0444 | Annual depression screen | 0.18 | Once per 12 months | Validated tool (PHQ-2 / PHQ-9) + documented score |
| G0537 | ASCVD risk assessment | 0.18 | Once per 12 months (primary prevention) | Pooled Cohort Equations + documented percent risk |
| 99497 | Advance care planning, first 30 min | 1.50 | Per encounter; add modifier 33 on AWV day to waive cost share | Documented ACP discussion, time, and who was present |
| G0136 | SDOH risk assessment, 5 to 15 min | 0.18 | Up to twice per 12 months | Validated tool (PRAPARE / AHC HRSN) + action on findings |
| 96160 | Patient-focused HRA | 0.05 | Per administration at the AWV | Named validated HRA instrument + score |
Same-day problem-oriented work
If the patient also needs problem-oriented care at the AWV, bill the AWV plus a problem-oriented E/M (99213 to 99215) with modifier 25 on the E/M, never on the AWV. Document the problem-oriented HPI, assessment, and plan separately from the AWV structural elements. Without modifier 25 the problem-oriented work bundles into the AWV and is uncompensated.
Frequently asked questions
Which AWV code do I bill: G0438 or G0439?
G0438 is the initial AWV, billed once per lifetime after the IPPE (G0402) window closes. G0439 is the subsequent AWV, billed every year after that, no sooner than 365 days from the prior AWV. Always check claims history before choosing.
Can I bill a problem-oriented visit on the same day as the AWV?
Yes. Bill the AWV (G0438 or G0439) plus a problem-oriented E/M (99213 to 99215) with modifier 25 on the E/M. Document the problem-oriented work separately from the AWV structural elements. Modifier 25 goes on the E/M, never on the AWV.
Does ACP (99497) have a patient cost share on AWV day?
No, when you append modifier 33 and perform it on the same day as the AWV. ACP billed on a non-AWV day or without modifier 33 may carry the standard cost share.
What is the single most-missed AWV add-on?
G0537 (ASCVD risk assessment) and 99497 (advance care planning) are the most under-billed. Both are routinely performed clinically at the AWV but not coded because the documentation hook (percent risk for G0537, the ACP discussion and time for 99497) is not captured.
The 365-day trap, next-eligible-date math, and the full add-on workflow.
Educational reference, not billing or legal advice. wRVU values reflect the 2026 CMS Physician Fee Schedule and should be reverified each January. Verify frequency rules and modifier policy against your payer contracts.