HCPCS Code G0439: Medicare Subsequent Wellness Visit

HCPCS code G0439 is used to bill Medicare for each subsequent Annual Wellness Visit (AWV) after a beneficiary’s initial visit (G0438). 

G0439 is reported once every 12 months to update the patient’s Personalized Prevention Plan of Service (PPPS), reassess health risks, and address gaps in preventive care.

G0439 falls under HCPCS Level II and is categorized within Counseling, Screening, and Prevention Services. 

The official CMS description of G0439 states: “Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit.”

In contrast to the initial AWV (G0438), which establishes a baseline health assessment and prevention plan, G0439 focuses on updating that plan based on changes in the patient’s health status, medications, and risk factors. 

The visit emphasizes preventive care planning, risk assessment, cognitive evaluation, and care coordination rather than a comprehensive physical exam.

Medicare covers G0439 at 100% under Part B, meaning no copay, coinsurance, or deductible for the patient when billed correctly as a preventive service. After the initial AWV, all future AWVs are billed using G0439 for the duration of the patient’s Medicare enrollment.

This G0439 billing guide explains eligibility rules, billing procedures, reimbursement, telehealth options, and compliance requirements to help ensure accurate and compliant Medicare claims processing.

How Does G0439 Differ From G0438?

G0438 covers the first Annual Wellness Visit. G0439 covers every Annual Wellness Visit after that. The core difference is clinical scope: G0438 requires building a complete baseline health risk assessment and prevention plan, while G0439 requires updating the existing one.

Feature	G0438 (Initial AWV)	G0439 (Subsequent AWV)
Visit type	First Annual Wellness Visit	Every AWV after the first
Frequency	Once per lifetime	Once every 12 months
Clinical focus	Build baseline HRA and PPPS	Update existing HRA and PPPS
2026 national avg. reimbursement	~$174	~$138
Eligibility start	12 months after Part B enrollment	12 months after the last G0438 or G0439
Patient cost	$0	$0
Depression screening (G0444)	Not permitted on the same claim	Permitted on the same claim

Why Does Medicare Use Multiple Annual Wellness Visit Codes?

Medicare uses three separate codes because each visit type requires different levels of clinical work and documentation, which means different resource costs.

• G0402 (Initial Preventive Physical Examination, or “Welcome to Medicare” visit) is a one-time benefit available only during the first 12 months of Part B enrollment. 
• G0438 follows after 12 months of enrollment and builds the comprehensive baseline that future visits reference. 
• G0439 then handles every annual update going forward.

Each code maps to a specific stage in the beneficiary’s Medicare care timeline. The IPPE orients a new enrollee to available preventive benefits. The initial AWV creates the detailed prevention plan. 

Subsequent AWVs keep that plan current as the patient ages and their health changes. This staged approach lets CMS reimburse providers accurately based on the actual work each visit requires.

Who Can Bill G0439?

Only certain provider types can perform and bill Medicare for a subsequent Annual Wellness Visit. CMS allows the following professionals to furnish G0439 services:

• Physicians (MD or DO)
• Nurse practitioners (NP)
• Physician assistants (PA)
• Certified clinical nurse specialists (CNS)

These providers bill under their own National Provider Identifier (NPI) and must operate within their state scope-of-practice laws.

CMS also permits a team of medical professionals to perform specific AWV components under the direct supervision of a physician. This team may include:

• Health educators
• Registered dietitians
• Nutrition professionals
• Other licensed practitioners

The supervising physician does not need to be present for every element, but must be immediately available in the office during the visit. This flexibility lets practices delegate HRA collection, screening questionnaires, and vitals to clinical support staff while the billing provider leads the cognitive assessment, prevention plan update, and care coordination.

Who Is Eligible for G0439 Services?

A patient qualifies for G0439 (Subsequent Annual Wellness Visit) if they meet all of the following:

• Enrolled in Medicare Part B
• At least 12 months have passed since their last AWV (either G0438 or a previous G0439)
• They have already completed their initial AWV (G0438)

Medicare uses a month-based eligibility rule, not a calendar-date rule. A patient who had their last AWV on April 10, 2025, becomes eligible again on April 1, 2026, not on the exact anniversary. This means patients can sometimes schedule their next AWV slightly before the 12-month mark from the actual service date.

There is no upper age limit. Any Medicare Part B beneficiary who has completed G0438 qualifies, whether they are 66 or 96. Medicare Advantage plans must also cover AWVs as a Part B preventive benefit, though reimbursement rates and documentation requirements may differ by plan.

Scenario: A 72-year-old patient enrolled in Medicare Part B in January 2020. She completed her IPPE (G0402) in March 2020, her initial AWV (G0438) in April 2021, and subsequent AWVs (G0439) every year since. Her most recent G0439 was May 15, 2025. She becomes eligible for her next G0439 on May 1, 2026.

What Does the Annual Wellness Visit Under G0439 Include?

The subsequent AWV requires updating, not recreating, the patient’s Personalized Prevention Plan of Service. Each element builds on the baseline established during the initial G0438 visit.

• Updating the PPPS: The provider reviews and revises the patient’s prevention plan based on current health status, new diagnoses, medication changes, and updated screening results. This plan includes a written schedule of recommended screenings, immunizations, and preventive services for the coming year.
• Health Risk Assessment (HRA) review: The patient completes or updates a structured questionnaire covering current health status, behavioral risks (tobacco use, alcohol consumption, physical activity), and psychosocial concerns. Many practices send this form to patients before the visit to save in-office time.
• Cognitive assessment: The provider evaluates the patient for signs of cognitive impairment using a structured observation or standardized tool. This is not a full dementia diagnosis, but a screening to identify patients who need further evaluation.
• Functional ability and safety screening: This covers fall risk, hearing and vision status, activities of daily living, and home safety concerns. Providers document whether the patient’s functional status has changed since the last AWV.
• Updated medical and family history: The provider records any new diagnoses, surgeries, hospitalizations, or changes in family health history since the last visit. Current medications and supplement lists are also updated.
• Screening schedule and referral checklist: Based on the updated HRA and medical history, the provider creates a checklist of due or overdue screenings (mammography, colonoscopy, bone density, etc.) and referrals to specialists.
• Social Determinants of Health (SDoH) assessment: Providers can assess food insecurity, housing stability, transportation access, and utility needs during the AWV. Note that effective January 1, 2026, CMS redefined code G0136 from SDoH assessment to physical activity and nutrition assessment. Practices collecting SDoH data during AWVs should verify which billing code applies under current rules.

How to Bill G0439 Correctly

Bill G0439 with the place of service code matching where the visit occurs: 11 for office, 02 for telehealth, or 10 for the patient’s home (telehealth from home). Eligible providers include physicians, nurse practitioners, physician assistants, and certified clinical nurse specialists. Other clinical staff, such as health educators and dietitians, may perform components of the AWV under the direct supervision of a physician.

• Modifier usage: G0439 itself does not require a modifier when billed as a standalone preventive service. If you bill a separate evaluation and management (E/M) code on the same date for a medically necessary problem, append modifier -25 to the E/M code to indicate a significant, separately identifiable service. If Advance Care Planning (CPT 99497) is provided during the AWV, add modifier -33 to waive the patient’s cost-sharing.
• Documentation essentials: The medical record must include the updated HRA, the revised PPPS, evidence of cognitive screening, updated medical/family history, and the screening schedule. Every required AWV element should be clearly documented. Missing even one component, especially the HRA, creates audit vulnerability.
• Billing G0439 with other codes on the same date: Medicare allows same-day billing of G0439 with a problem-oriented E/M visit (such as 99214 or 99215) when the E/M service is medically necessary and separately documented. The AWV portion remains at $0 patient cost; standard cost-sharing applies only to the E/M component. Starting in 2025, the G2211 complexity add-on code can also be billed alongside AWVs.

Additional AWV-related codes that may apply:

• G0444: Annual depression screening (15 minutes), billable only with G0439, not with G0438
• G0442/G0443: Alcohol misuse screening and counseling
• G0447: Obesity counseling (BMI 30+)
• 99497/99498: Advance Care Planning
• G0136: Physical activity and nutrition assessment (redefined for 2026)
• G0468: FQHC add-on code for AWVs performed in Federally Qualified Health Centers

Common Denial Reasons for G0439 Claims

Below are the common denial reasons for G0439 claims:

• Frequency violations. Billing G0439 before 12 full months have passed since the last AWV is the most common denial trigger. CMS systems automatically reject claims that violate the once-per-12-months rule.
• Missing or incomplete documentation. If the HRA is absent from the medical record, auditors can deny the entire AWV claim even when all other elements were performed. The same applies to a missing or incomplete PPPS update.
• Incorrect beneficiary eligibility status. Filing G0439 for a patient who never had an initial AWV (G0438) on record causes denials. This also happens when billing G0439 for a patient still within their first 12 months of Part B enrollment.
• Overlooked detail most practices miss: Depression screening (G0444) billed alongside G0438 instead of G0439 triggers a denial for the screening code. G0444 is only valid with subsequent AWVs, not the initial visit. This is one of the most frequently misunderstood AWV bundling rules.

How to Prevent G0439 Claim Denials

Tips to prevent G0439 claim denials are outlined below:

• Verify eligibility before scheduling: Check the patient’s Medicare claims history through the CMS HIPAA Eligibility Transaction System (HETS) or your eligibility services provider. Confirm the date of their last AWV (G0438 or G0439) and calculate the earliest eligible date using the month-based rule.
• Use pre-visit workflows: Send the HRA questionnaire to the patient before the appointment. Make HRA completion a hard requirement before the visit can be billed. Build automated flags in your scheduling system that prevent G0439 from being scheduled before the 12-month window opens.
• Document every required element: Create an AWV-specific documentation template that includes checkboxes or sections for each mandatory component: HRA, PPPS update, cognitive assessment, functional screening, updated history, and screening schedule. An incomplete template signals a billing hold, not a clean claim.

What Is the Reimbursement Rate for G0439?

The 2026 national average Medicare reimbursement for G0439 is approximately $138. This figure comes from the Medicare Physician Fee Schedule and represents a non-facility (office) payment. Facility rates (hospital outpatient settings) are typically lower because the facility bills separately for overhead costs.

Actual payment varies by geographic locality. CMS applies Geographic Practice Cost Indices (GPCI) that adjust the base rate for differences in work costs, practice expenses, and malpractice costs across regions. A provider in Manhattan receives a higher adjusted payment than a provider in rural Oklahoma for the same code.

Can G0439 Be Delivered via Telehealth?

Yes. CMS covers G0438 and G0439 when provided through telehealth. This was expanded beginning in 2020 and has continued through 2026.

• Place of service codes: Bill telehealth AWVs with place of service code 02 (telehealth, patient outside home) or POS code 10 (patient at home). Some payers accept POS 11 with modifier 95 or GT as an alternative. Check your Medicare Administrative Contractor’s (MAC) guidance for the preferred format.
• Technology requirements: The visit should use real-time audio and video technology. If the patient lacks video capability, document in the medical record that services were provided via audio-only due to patient technology limitations. The provider must have an established relationship with the patient before conducting a telehealth AWV.
• Documentation considerations: All standard AWV documentation requirements still apply for telehealth visits. The HRA must be completed (often sent electronically beforehand). The key difference: body mass index and blood pressure measurements are not required for telehealth AWV claims. Weight and blood pressure can be self-reported or deferred. However, self-reported blood pressure readings only close HEDIS care gaps if they were collected using a digital device and documented in the medical record.
• Patient consent: The patient must verbally or virtually consent to the telehealth visit format, and that consent must be documented in the medical record before the visit begins.

Scenario: A rural practice uses telehealth to deliver subsequent AWVs for patients who live more than 45 minutes from the clinic. The patient completes the HRA online before the visit. During the video call, the provider reviews the HRA, conducts a cognitive screening using a validated tool, updates the patient’s medical history, and revises the prevention plan. The practice bills G0439 with POS 02 and documents the telehealth consent. Blood pressure is self-reported from a home monitor. The claim processes at $0 patient cost.

Compliance and Regulatory Considerations For G0439

CMS updates the Medicare Physician Fee Schedule annually, which can change AWV reimbursement rates, covered screening services, and documentation requirements. The 2026 fee schedule redefined G0136 from an SDoH assessment to a physical activity and nutrition assessment. The 2025 fee schedule allowed the G2211 complexity add-on to be billed with AWVs. These changes happen every year without fail.

• Audit risk areas: The 24.5% improper payment rate for AWVs means this service category receives above-average audit scrutiny. The most common audit findings include missing HRA documentation, incomplete PPPS updates, and claims billed before the 12-month eligibility window. Practices should conduct internal audits of AWV claims at least quarterly, checking for completeness of documentation and compliance with frequency requirements.
• Staying current: Review CMS transmittals and MLN Matters articles each fall before the January 1 effective date for any changes to AWV coverage, coding, or documentation rules. Subscribe to the CMS MLN Connects newsletter for timely updates. Verify add-on code compatibility annually since CMS regularly revises which codes can be billed alongside G0438 and G0439.
• FQHC-specific rules: Federally Qualified Health Centers use additional code G0468 alongside G0438 or G0439 to reflect FQHC-specific payment methodologies. Payment rates for FQHCs differ significantly from standard fee schedule amounts and should be verified separately.
• Medicare Advantage plans: MA plans must cover AWVs as a Part B preventive benefit, but individual plans may impose different documentation requirements or use different claims processing rules. Verify AWV billing procedures with each MA plan before submitting claims.

Final Words

G0439 represents a reliable, recurring revenue opportunity for practices that serve Medicare patients. It costs patients nothing, it supports preventive care and value-based quality measures, and it opens the door to enrolling patients in chronic care management and remote monitoring programs. The key to capturing this revenue consistently is simple: verify eligibility before every visit, document every required element, and never confuse the AWV with a physical exam. Practices that build structured AWV workflows around these principles reduce denials, pass audits, and deliver better preventive care to their patients year after year.