Medicare Annual Wellness Visit: G0438 vs G0439 Explained

Updated October 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

The Medicare Annual Wellness Visit (AWV) is a yearly preventive visit that builds or updates a patient's personalized prevention plan. G0438 is the first AWV and G0439 covers every one after it, each billable once in 12 months. In 2026 the national payment is about $174.35 for G0438 and $137.61 for G0439, and patients owe nothing when the practice accepts assignment.

From the clinical side, the cognitive and depression reviews are the parts of the AWV I'd protect first, because they're easy to rush and hard to catch later.

Key facts

• Codes: G0438 is the initial AWV and G0439 is the subsequent AWV, and either can be billed once every 12 months (CMS, Annual Wellness Visit).
• Patient cost: Patients pay nothing for the AWV if the provider accepts assignment (CMS, Medicare Wellness Visits).
• Eligibility: The patient can't be within 12 months of their first Part B effective date, and can't have had an IPPE or AWV in the past 12 months (CMS, AWV compliance tips, 2026).
• 2026 payment: The conversion factor is $33.4009 (CMS PFS data, 2026). That works out to about $174.35 for G0438 and $137.61 for G0439 nationally, before local adjustment.
• Improper payments: The 2024 overpayment rate for AWVs including G0439 was 24.5%, a projected $307.5 million (CMS, AWV compliance tips, 2026).
• Uptake: In 2020, 45% of community living Medicare beneficiaries had an AWV (CMS, MCBS 2020 preventive care tables).
• Not a physical: A routine physical exam isn't covered, and patients pay 100% of it (CMS, Medicare Wellness Visits).

What is the Medicare Annual Wellness Visit?

The AWV is a prevention planning visit, not a head to toe exam. Its job is to collect a health risk assessment, review history and risk factors, and leave the patient with a written plan for the next 5 to 10 years of screenings and referrals.

CMS describes the goal as health promotion and disease detection. The visit encourages patients to use preventive services Medicare already covers, and it's the one visit built around the patient's whole picture rather than one complaint.

That's also why it gets confused with a physical. Medicare doesn't cover a routine physical, which CMS defines as an exam done without relation to treatment or diagnosis of a specific illness, symptom, complaint or injury. Patients pay 100% of that. The AWV is the covered alternative, and front desk staff need to say so clearly when a patient asks for a "yearly physical."

What's the difference between G0438 and G0439?

G0438 is the first AWV a patient ever gets, and G0439 is every AWV after that. The split matters because the first visit asks for more.

The initial visit includes a full health risk assessment, a complete medical and family history, a list of current providers and suppliers, height, weight and blood pressure, a cognitive check, a depression risk review, and a review of functional ability and safety. The subsequent visit updates most of that. It drops the height measurement and the depression and functional ability reviews as required steps, and keeps the cognitive check.

Two practical points follow. First, G0438 is billed once per patient, so check the claim history before scheduling. Second, the payment gap is real. At 2026 national rates G0438 pays about $36.74 more than G0439, because the first visit carries more work.

Who is eligible for an AWV, and how often?

A patient is eligible once they're past their first 12 months of Part B and haven't had an AWV or an Initial Preventive Physical Exam (IPPE) in the past 12 months. CMS covers the AWV once every 12 months.

Use this checklist before you book:

1. Confirm the patient has had Part B for more than 12 months.
2. Check that the patient didn't have an IPPE (G0402) in the past 12 months. CMS denies G0438 and G0439 within 12 months of a G0402 for the same patient.
3. Check that the last AWV date of service is at least 12 months back.
4. Confirm the visit will be done by an eligible health professional.

Eligible professionals include physicians, physician assistants, nurse practitioners and clinical nurse specialists. A medical professional or team of them working under a physician's direct supervision can also furnish the visit (CMS, MLN Matters MM13486).

What does Medicare require in an AWV?

Medicare requires a health risk assessment plus a defined set of review and planning steps, and the chart has to show them. CMS publishes the elements, so build your template from its list rather than from memory.

For the first AWV, the required work includes:

• Health risk assessment: Patient reported demographics, health status, psychosocial and behavioral risks, and activities of daily living.
• History and providers: Medical, surgical and family history, plus a list of current providers and suppliers.
• Measurements: Height, weight, BMI or waist circumference, and blood pressure.
• Cognitive and depression review: Detect cognitive impairment, and review depression risk factors.
• Function and safety: Ability to perform daily activities, fall risk, hearing, and home safety.
• Written screening schedule: Based on USPSTF and ACIP recommendations and the patient's own risk profile.
• Personalized advice and referrals: Fall prevention, nutrition, physical activity, tobacco cessation and similar programs.
• Opioid and substance use review: Review current opioid prescriptions and screen for substance use risk.

Advance care planning happens at the patient's discretion and is optional. CMS also lists an optional physical activity and nutrition risk assessment, reported with G0136. Outside the AWV, cost sharing applies to advance care planning (CMS, Annual Wellness Visit).

How much does Medicare pay for G0438 and G0439, and where do claims go wrong?

Medicare pays by relative value units (RVUs) times a conversion factor, and for 2026 the factor is $33.4009. At national rates, G0438 carries about 5.22 total RVUs and G0439 about 4.12.

Here's the arithmetic, line by line:

• G0438: 5.22 RVUs x $33.4009 = about $174.35.
• G0439: 4.12 RVUs x $33.4009 = about $137.61.
• Gap: $174.35 minus $137.61 = $36.74.

Your actual payment moves with your locality's geographic adjustments, and CMS resets the rates each January. CMS publishes the files in its PFS relative value files, so reconcile against your own remittance.

Where do claims fail? CMS reported a 24.5% overpayment rate for AWVs including G0439 in the 2024 reporting period. That's a signal to audit your own workflow. The usual failure points are billing a patient too soon after a prior AWV or IPPE, and a record that doesn't show the required elements. When an AWV runs across several days, the date of service you report is the day you complete the whole visit.

How does the AWV connect to care management?

The AWV can serve as the initiating visit for chronic care management (CCM). CMS requires an initiating visit for new patients or patients you haven't seen in the past year, and it accepts a comprehensive E/M visit, an AWV or an IPPE.

There's one catch. If you don't discuss CCM during the AWV, it can't count as the initiating visit (CMS, MLN909188). So the conversation has to happen and be documented.

That makes the AWV a natural place to spot patients with two or more chronic conditions expected to last at least 12 months. For the rules once a patient is identified, see our guide to what CCM is and the CCM consent and care plan requirements.

CMS frames the AWV's goal as health promotion and disease detection. That's a process goal, and I'm not claiming the visit alone improves outcomes. Treat it as a workflow opening, not a proven treatment.

What this means for your practice

Treat the AWV as a scheduling and documentation problem first. The revenue is modest per visit, but the visit feeds everything else, including CCM enrollment and screening follow through.

A few steps that keep it clean:

1. Build one AWV template from the CMS element list, with separate initial and subsequent versions.
2. Run an eligibility check before every booking, covering Part B start date, IPPE history and last AWV date.
3. Add a CCM prompt to the template so the discussion is documented when it's clinically appropriate.
4. Decide who owns reminder outreach, because a visit that isn't scheduled can't be billed.
5. Audit a small sample of AWV charts each quarter against the CMS elements.

At HANA Health, we work on the patient outreach side of care management, the calls and follow ups that help patients show up and finish what they start. If outreach is where your program stalls, our practice page explains how we approach it. If patients also drop out after enrollment, our post on why patients drop out of CCM covers that side.

Frequently asked questions

Is a yearly physical covered by Medicare?

No. CMS treats a routine physical exam as not covered, and patients pay 100% of the cost. The covered options are the one time IPPE in the first 12 months of Part B and the AWV after that.

Can an AWV be completed over more than one day?

Yes. CMS says you may provide elements of the AWV over multiple days. You report the date of service on which you complete the entire visit, and your records should show the work started on one day and finished on another.

Who can perform an AWV?

A physician, physician assistant, nurse practitioner or clinical nurse specialist can. A medical professional or a team working under a physician's direct supervision can also furnish it, as set out in 42 CFR 410.15(a).

What if the patient had an IPPE recently?

Then G0438 and G0439 will deny. CMS won't pay either code within 12 months of a G0402 for the same patient, and the claim comes back with a benefit maximum message.

Can I address a new problem during the same visit?

Clinically, patients often raise problems during a wellness visit. A problem oriented visit is a separate service with its own documentation. Check your MAC's rules on same day billing before you build the workflow.

Sources

1. Centers for Medicare & Medicaid Services, Annual Wellness Visit, accessed October 2026.
2. Centers for Medicare & Medicaid Services, Medicare Wellness Visits, April 2026.
3. Centers for Medicare & Medicaid Services, Annual Wellness Visits, Medicare Provider Compliance Tips, February 2026.
4. Centers for Medicare & Medicaid Services, MLN Matters MM13486, Annual Wellness Visit, 2024.
5. Centers for Medicare & Medicaid Services, MLN909188, Chronic Care Management Services, June 2025.
6. Centers for Medicare & Medicaid Services, PFS Relative Value Files, RVU26D, 2026.
7. Centers for Medicare & Medicaid Services, Physician Fee Schedule indicators for 2026, updated October 2026.
8. Centers for Medicare & Medicaid Services, MCBS 2020 PUF on Use of Preventive Care Services, 2023.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you want to talk through how to run this at your practice, you can book a discovery call.