G0438 and G0439 Medicare Annual Wellness Visits

How to Bill Annual Wellness Visits

Medicare provides coverage for Annual Wellness Visits (AWV). The codes are G0438 andG0439. So what are the definitions of the codes?

G0438 Annual Wellness Visit, Initial (AWV)

Annual wellness visit, including a personalized prevention plan of service (PPPS), first visit.

G0439 Annual Wellness Visit, Subsequent (AWV)

Annual Wellness visit, including a personalized prevention plan of service (PPPS), subsequent visit.

The Annual Wellness Visits codes are not specific to new or established patients. The same codes can be used for either.

An Annual Wellness Visit, G0438, can be done on patients that have been enrolled with Medicare for at least one year. A patient is eligible for their subsequent AWV, G0439, one year after their initial G0438.

For the first year a patient is enrolled with Medicare they are eligible for a Welcome to Medicare visit, G0402, or officially know as IPPE, Initial Preventative Physical Exam. Want to know more about the Welcome to Medicare visit?  You can find more information at CMS.

What is included in an AWV?

Here is a quick summary.

  • Medical and family history
  • List of current medical providers
  • Height, weight, BMI, BP and other appropriate routine measurements
  • Detection of cognitive impairment
  • Review risk factors
  • Review of functional ability
  • Establish a written screening schedule for next 5-10 years
  • Establish list of risk factors
  • Provide advice and referrals to health education and preventative counseling services
  • Other elements as determined by the Secretary of Health and Human Services

For  more information checkout MLN Matters Number MM7079 from Medicare for a list of services that must be provided at the AWV and subsequent AWV to be billable.

An Annual Wellness Visit is not a Complete Physical Exam or Well Check, 99387 and 99397.  Well Checks for Medicare patients are not covered by Medicare. 

For additional information, specifics and more details visit the CMS or you local Medicare carrier’s website or contact them directly.

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