Medicare Annual Wellness Visit Codes: G0402, G0438, and G0439

Medicare Annual Wellness Visit (AWV) is a preventive healthcare service under Medicare Part B designed to develop or update a personalized prevention plan using patient-specific risk factors, medical history, and screening data.

Medicare AWV billing uses HCPCS codes G0402 (Initial Preventive Physical Examination), G0438 (initial AWV), and G0439 (subsequent AWV), each tied to a defined eligibility timeline and documentation standard.

Preventive AWV services include structured health risk assessment (HRA), cognitive and depression screening, functional status evaluation, and a written screening and immunization schedule.

Authorized under the Affordable Care Act in 2011, Medicare AWV coverage eliminates patient cost-sharing when billed correctly, reinforcing value-based care delivery and proactive population health management.

This guide covers Medicare Annual Wellness Visit codes G0402, G0438, and G0439, including eligibility rules, required documentation, billing workflows, reimbursement details, and compliance requirements to ensure accurate coding and maximum reimbursement.

How the AWV Differs from a Routine Physical Exam

Many patients and even some billing staff confuse the AWV with a standard physical exam. They serve different purposes.

A routine physical involves hands-on examination of body systems, vital signs assessment, and often lab work. Medicare does not cover routine physicals for most beneficiaries.

The AWV centers on reviewing health risks, updating prevention plans, screening for cognitive impairment, assessing functional ability, and creating a written screening schedule. A provider may take vitals, but a head-to-toe physical examination is not a required or reimbursable component of the AWV.

Example: A 72-year-old patient asks her doctor for “her annual physical.” The front desk schedules an AWV. During the visit, the physician completes the health risk assessment, updates her prevention plan, and screens for depression and cognitive decline. The patient then mentions knee pain. The provider addresses the knee as a separate problem-oriented visit and bills an E/M code with modifier 25 alongside the AWV code.

Medicare Eligibility Requirements for AWV

To qualify for a Medicare AWV, patients must:

• Be enrolled in Medicare Part B
• Have had Part B coverage for longer than 12 months (for the initial AWV, G0438)
• Not have received an AWV or IPPE within the past 12 months

Important timing rule: Medicare uses a month-based eligibility rule. After an AWV or IPPE, the patient becomes eligible again on the first day of the same calendar month the following year. For example, a patient who had an AWV on March 15, 2025, becomes eligible again on March 1, 2026, not on the exact anniversary date and not on January 1, 2026.

What Are the CPT Codes for Annual Wellness Visits?

Medicare uses three HCPCS codes for wellness visits: G0402 for the Initial Preventive Physical Examination, G0438 for the first Annual Wellness Visit, and G0439 for every subsequent Annual Wellness Visit. Each code applies to a specific stage of a beneficiary’s Medicare enrollment timeline.

G0402: Initial Preventive Physical Examination (IPPE)

G0402 covers the “Welcome to Medicare” preventive visit available only to new Medicare beneficiaries within their first 12 months of Part B enrollment. This is a one-time benefit.

Who Qualifies

A patient qualifies for G0402 if their Medicare Part B effective date falls within the preceding 12 months. For example, a beneficiary whose Part B starts July 1, 2025, can receive the IPPE anytime from July 1, 2025, through June 30, 2026.

After the 12-month window closes, the patient can never receive a G0402 visit. Many beneficiaries miss this window entirely because they are unaware it exists.

Required Components and Documentation

The IPPE requires:

• Review of the patient’s medical and social history, including past medical and surgical history, current medications and supplements, and family history
• Review of potential risk factors for depression and other mood disorders, using standard screening tests recognized by national professional medical organizations
• Review of functional ability and level of safety, including fall risk
• An examination including height, weight, BMI, blood pressure, and visual acuity screening
• End-of-life planning discussion (required with the patient’s consent; this is a mandated element of the IPPE, not an optional add-on; the patient may decline)
• Education, counseling, and referral based on findings
• A brief written plan for screening, including referral for a screening electrocardiogram (ECG) when appropriate, and other separately covered Medicare Part B preventive services

The provider must document each component clearly. Missing documentation on any required element can trigger claim denials.

Reimbursement Details Of G0402

Medicare reimburses G0402 at approximately $114.23 to $174.69 under the Physician Fee Schedule, though rates vary by geographic locality. The patient pays $0 out of pocket when the provider accepts assignment. The Part B deductible does not apply to this service. Note that the ECG screening codes (G0403–G0405), if performed, are subject to separate cost-sharing rules.

G0438: Initial Annual Wellness Visit

G0438 is the code for a patient’s first Annual Wellness Visit. This visit becomes available 12 months after the patient’s Part B effective date, regardless of whether the patient received a G0402 IPPE.

Eligibility Criteria

A patient qualifies for G0438 when:

• At least 12 months have passed since their Part B enrollment date
• They have never previously received an AWV (G0438 or G0439)

If a patient enrolled in Part B on January 1, 2024, and never received any preventive wellness visit, they first become eligible for G0438 on January 1, 2025. If the patient completed an IPPE, they become eligible for G0438 on the first day of the same calendar month the following year.

Required Components

G0438 requires structured documentation, including:

• Health Risk Assessment (HRA): A standardized questionnaire covering, at minimum, demographics (age, sex, race, ethnicity), self-assessment of health status and frailty, psychosocial risks, behavioral risks (including tobacco use, physical activity, nutrition, and oral health), activities of daily living (ADLs such as dressing, feeding, toileting, grooming, and physical ambulation including fall risk), and instrumental activities of daily living (IADLs such as shopping, housekeeping, managing medications, and handling finances)
• Medical and family history review: Comprehensive past medical, surgical, and family history, plus a current medication list with all prescribed and over-the-counter drugs, supplements, and vitamins
• List of current providers and suppliers involved in the patient’s care
• Functional ability and safety screening: Assessment of hearing, fall risk, home safety, and ability to perform activities of daily living
• Cognitive impairment detection: Through direct observation, a brief validated screening tool, patient/family reports, or a combination, CMS does not mandate a specific tool, though commonly used instruments include the Mini-Cog, MMSE, MoCA, and others at the clinician’s discretion
• Depression screening: Using a standardized instrument such as PHQ-2 or PHQ-9
• Personalized prevention plan: A written plan including screening schedule, immunization schedule, and a list of current risk factors with interventions; this plan must be furnished to the patient (physical copy or patient portal)
• Height, weight, BMI (or waist circumference), and blood pressure

How G0438 Differs from G0402

G0438 requires a completed Health Risk Assessment questionnaire, which G0402 does not. G0438 also mandates a formal cognitive screening, while G0402 only requires a review of functional ability. The personalized prevention plan under G0438 is more detailed and must include a specific screening schedule tailored to the patient’s risk profile.

The IPPE (G0402) includes a physical examination component with visual acuity screening. The AWV (G0438) does not require a traditional exam or visual acuity testing beyond height, weight, BMI, and blood pressure.

G0439: Subsequent Annual Wellness Visit

G0439 covers every Annual Wellness Visit after the initial one. Providers bill this code for patients who have already received either a G0438 or a prior G0439 at least 12 months earlier.

When to Use G0439 vs. G0438

Bill G0438 only once per patient, ever. Every AWV after the first one uses G0439. If a patient had their initial AWV (G0438) in February 2024, their next AWV in February 2025 or later uses G0439. Every annual visit going forward also uses G0439.

Common mistake: Some practices bill G0438 each year, treating it like an annual reset. Medicare will deny the claim. G0438 is strictly a one-time code per beneficiary.

Required Components and Updates

G0439 requires the same core elements as G0438, with the focus on updating rather than creating:

• Updated Health Risk Assessment
• Updated medical and family history, including any new diagnoses, procedures, or medications since the last visit
• Updated list of current providers and suppliers involved in the patient’s care
• Cognitive impairment detection and depression screening
• Updated personalized prevention plan with revised screening schedule
• Weight, blood pressure, and other measurements as appropriate

Note: CMS regulations specify height and BMI as required measurements for the initial AWV (G0438) but do not explicitly require them for subsequent AWVs (G0439). Weight and blood pressure are required for G0439. Many practices choose to measure height and calculate BMI at every visit as best practice, but providers should be aware of this distinction for documentation purposes.

Frequency and Timing Rules

Medicare covers G0439 once every 12 months. Patients become eligible again on the first day of the same calendar month the following year. A patient seen for G0439 on April 10, 2025, becomes eligible again on April 1, 2026.

Why Are There Multiple AWV HCPCS Codes?

Medicare created three codes to reflect three distinct stages in a beneficiary’s preventive care timeline, each with different clinical requirements, documentation standards, and reimbursement rates.

Timeline Logic: IPPE to Initial AWV to Subsequent AWV

The progression follows this sequence:

1. G0402 (IPPE): Available during the first 12 months of Part B enrollment. One-time only.
2. G0438 (Initial AWV): Available starting 12 months after Part B enrollment. One-time only. Reimbursed at approximately 50% more than G0439 to account for the additional work of establishing baseline documentation.
3. G0439 (Subsequent AWV): Available 12 months after the last G0438 or G0439. Repeats annually.

A patient can receive both G0402 and G0438 in their lifetime, but never during the same 12-month period. The earliest a patient can receive a G0438 is 12 months after their Part B start date.

How the Patient Enrollment Date Determines Which Code Applies

Example scenario: Maria enrolls in Medicare Part B on March 1, 2025.

• March 1, 2025, through February 28, 2026: Eligible for G0402 (IPPE)
• March 1, 2026, onward: Eligible for G0438 (Initial AWV) if she has never had one
• March 1, 2027, onward (first day of the month, 12 months after G0438): Eligible for G0439 (Subsequent AWV)

If Maria skips the IPPE entirely and comes in for her first wellness visit in June 2027, the correct code is G0438 because she has never received an initial AWV, even though years have passed since enrollment.

What Are the Key Components of a Medicare Annual Wellness Visit?

Every AWV must include the core components listed below. Missing any of them risks claim denial and audit exposure.

Health Risk Assessment

The HRA is a patient-completed questionnaire that collects self-reported data on demographics, health status, psychosocial and behavioral risk factors, activities of daily living, and instrumental activities of daily living. CMS does not mandate a specific HRA form, but the tool must capture all required data elements.

Many practices send the HRA to patients electronically before the visit to save time. Practices that collect the HRA at check-in often run behind schedule because the questionnaire takes 10 to 15 minutes to complete.

Medical and Family History Review

The provider must document a comprehensive review of the patient’s past medical and surgical history, family history of chronic diseases, and a full medication reconciliation. This includes prescription drugs, over-the-counter medications, herbal supplements, and vitamins.

For subsequent visits (G0439), the focus shifts to documenting changes since the last AWV rather than repeating the full history.

Functional Ability and Cognitive Screening

Functional screening covers hearing, fall risk, home safety, activities of daily living, and the patient’s ability to manage independently. CMS requires that providers detect cognitive impairment using direct observation during the visit, information from the patient and family/caregivers, a brief validated screening tool, or a combination of these approaches. CMS does not require a specific cognitive screening instrument; clinicians may choose from tools such as the Mini-Cog, MMSE, MoCA, SLUMS, or others at their discretion.

Cognitive screening during the AWV does not require the extended assessment billed under 99483. The AWV cognitive screen is brief and meant to identify patients who need further evaluation.

Personalized Prevention Plan

The prevention plan is the centerpiece of the AWV. It must include a tailored screening schedule (colonoscopy, mammography, bone density, etc.), an immunization schedule, and a list of identified risk factors with specific recommendations.

The plan must be documented in writing and furnished to the patient, either as a physical copy or through the patient’s health portal. Verbally discussing recommendations without providing written documentation does not meet CMS requirements.

Advance Care Planning (Add-on Code 99497/99498)

Advance care planning (ACP) can be billed in addition to the AWV using CPT code 99497 for the first 30 minutes and 99498 for each additional 30 minutes. ACP involves discussing the patient’s wishes regarding future medical treatment, including living wills, healthcare proxies, and end-of-life preferences.

When billed with the AWV on the same date by the same provider using modifier -33, the first ACP session (99497) is covered at no cost to the patient, once per year. If ACP is billed on a separate date of service or exceeds the once-per-year limit with the AWV, the Part B deductible and coinsurance apply. There are no limits on the number of times ACP can be reported for a patient in a given period, provided documentation supports changes in the patient’s health status or wishes.

What Are the Billing Requirements for Annual Wellness Visits?

According to CMS, Medicare Part B covers an AWV when performed by:

• Physicians (MD/DO)
• Qualified non-physician practitioners: physician assistants, nurse practitioners, or certified clinical nurse specialists
• A medical professional or team of medical professionals (including health educators, registered dietitians, nutrition professionals, or other licensed practitioners) working under the direct supervision of a physician

These providers must perform the visit themselves or directly supervise the clinical components. The supervising provider must be present in the office suite during the visit.

Note for FQHCs and RHCs: In FQHC and RHC settings, the AWV must be provided by a practitioner who meets the facility’s definition of a visit: physician (MD or DO), nurse practitioner, physician assistant, or certified nurse midwife.

Billing Under Incident-to Provisions

Clinical staff (such as medical assistants or registered nurses) can collect portions of the AWV data under “incident-to” billing rules when a physician or qualifying provider supervises. However, the billing provider must personally perform or oversee certain elements, including the cognitive screening and the creation or update of the personalized prevention plan.

The supervising provider must be present in the office suite during the visit and immediately available to assist. Practices that rely entirely on clinical staff to conduct AWVs without appropriate supervision risk compliance violations.

Which ICD-10 Codes Are Used for AWV Claims?

CMS does not require a specific diagnosis code for AWV claims; providers may choose any diagnosis code consistent with the patient’s exam. Commonly used codes include:

ICD-10 Code	Description	When to Use
Z00.00	General exam, no abnormal findings	Primary AWV diagnosis when screening results are normal
Z00.01	General exam, abnormal findings	Primary AWV diagnosis when screening reveals abnormalities
Z23	Encounter for immunization	When vaccines are administered during the AWV
Z71.89	Other specified counseling	When counseling occurs beyond standard AWV components

Common claim submission errors to avoid:

• Using a problem-oriented ICD-10 code (like E11.9 for diabetes) as the primary diagnosis on the AWV claim line. Lead with an appropriate preventive Z code.
• Failing to append modifier 25 to the E/M code when billing a problem-oriented visit on the same day as the AWV.
• Submitting G0438 for a patient who previously received an initial AWV, resulting in automatic denial.

Step-by-Step Guide to Billing an AWV

Pre-visit preparation:

1. Verify the patient’s Medicare eligibility and confirm Part B enrollment dates.
2. Check the date of the patient’s last AWV or IPPE to confirm eligibility. Remember: the patient is eligible on the first day of the same calendar month the following year.
3. Send the Health Risk Assessment questionnaire to the patient before the appointment.
4. Gather current medication lists, immunization records, and prior screening results.

Documentation during the visit:

1. Collect and review the completed HRA.
2. Update or create the medical and family history.
3. Perform and document depression and cognitive screenings with results and tool names.
4. Assess functional ability and fall risk.
5. Develop or update the personalized prevention plan with a written screening and immunization schedule.
6. Document all findings, counseling provided, and referrals made.
7. Furnish the prevention plan to the patient.

Claim submission workflow:

1. Select the correct HCPCS code: G0402, G0438, or G0439.
2. Assign an appropriate diagnosis code (e.g., Z00.00 or Z00.01).
3. If a separate problem-oriented E/M visit occurred, append modifier 25 to the E/M code.
4. Submit with the rendering provider’s NPI.
5. Confirm the place of service code (11 for office, 22 for outpatient hospital, etc.).

What Additional CPT and HCPCS Codes Can Be Billed With an AWV?

The AWV frequently serves as a gateway to additional billable services. Several codes pair with AWV visits when documentation supports medical necessity.

Code	Service	Notes
G0444	Annual depression screening (5 to 15 minutes)	Bundled into G0402 and G0438. It can’t be billed separately with those codes. CAN be billed separately with G0439 (subsequent AWV). Requires a standardized screening tool.
G0442	Annual alcohol misuse screening	Billable once per 12 months
G0443	Brief alcohol misuse counseling	Billable up to 4 times per 12 months; requires prior G0442 within preceding 12 months
96127	Brief emotional/behavioral assessment	Billable for standardized screening tools (PHQ-9, GAD-7)
99497	Advance care planning, first 30 minutes	Covered at $0 when billed with AWV (modifier -33)
99498	Advance care planning, additional 30 minutes	Coinsurance may apply

Important note on G0444: Many practices miss this revenue opportunity. Depression screening is a required component of the IPPE (G0402) and initial AWV (G0438), so G0444 is bundled into those codes and cannot be separately billed. However, for subsequent AWVs (G0439), depression screening is not bundled, and G0444 should be billed separately when the screening is performed and documented with a standardized tool.

Social Determinants of Health Assessments

For services through December 31, 2025: HCPCS code G0136 (administration of a standardized, evidence-based SDOH risk assessment tool, 5 to 15 minutes) was available for assessing patients’ social needs. This code was established in the CY 2024 Physician Fee Schedule and was an assessment, not a screening. CMS specified it should only be used when the practitioner has reason to believe there are unmet SDOH needs interfering with diagnosis or treatment. When performed with the AWV, G0136 had no beneficiary cost-sharing (billed with modifier -33). When performed with E/M visits, standard cost-sharing applied.

Effective January 1, 2026: CMS redefined G0136 to cover the assessment of physical activity and nutrition rather than SDOH. Practices should verify current coding guidance for SDOH-related assessments going forward.

Cognitive Assessment and Care Planning

If the AWV cognitive screen reveals potential impairment, the provider may schedule a full cognitive assessment and care plan under CPT 99483. This code covers a comprehensive evaluation, including cognitive testing, functional assessment, caregiver needs evaluation, and creation of a care plan. Code 99483 cannot be billed on the same date as the AWV; it requires a separate visit.

When E/M Codes Can Be Billed Alongside AWV Codes

Providers can bill a separate Evaluation and Management (E/M) code on the same day as the AWV when the patient presents with a new or existing medical problem that requires clinical decision-making beyond the scope of the AWV. The key requirements:

• The medical problem must be distinct from the preventive services in the AWV.
• The provider must append modifier 25 to the E/M code.
• Documentation must clearly separate the AWV components from the problem-oriented work.

Note: Starting January 1, 2025, CMS allows the office/outpatient E/M visit complexity add-on code G2211 to be billed with modifier 25 on the same day as AWV codes G0438 and G0439.

Example: During a G0439 visit, a 68-year-old patient reports new chest tightness with exertion. The provider performs a separate cardiovascular evaluation, orders an EKG, and adjusts the patient’s medication. The practice bills G0439 for the AWV and 99214-25 for the problem-oriented visit, with the appropriate cardiac diagnosis code linked to the E/M service.

How Do Annual Wellness Visit Codes Differ by Age Group?

Annual Wellness Visit (AWV) codes do not change by age group. The same codes apply to all eligible Medicare patients, but the preventive services and screening recommendations within the visit vary based on age and risk.

Younger Adults (18 to 39)

Medicare AWV codes apply almost exclusively to beneficiaries aged 65 and older or those under 65 who qualify for Medicare through disability or end-stage renal disease. Younger adults covered by Medicare follow the same AWV coding rules, but screening recommendations within the prevention plan differ. Cancer screenings, bone density tests, and cardiovascular risk assessments follow USPSTF guidelines appropriate to the patient’s age and risk profile.

Adults (40 to 64)

Medicare beneficiaries under 65 typically qualify through Social Security Disability Insurance. These patients are eligible for G0402, G0438, and G0439 on the same timeline as older adults. The personalized prevention plan should reflect age-appropriate screenings such as diabetes screening (starting at 35), hepatitis C screening (for those born between 1945 and 1965), and lung cancer screening for eligible smokers.

Seniors (65 and Older)

Most AWV encounters involve patients 65 and older. The prevention plan for this population emphasizes fall prevention, cognitive monitoring, immunizations (pneumococcal, shingles, influenza, COVID-19), cancer screenings aligned with life expectancy, and cardiovascular risk management. Providers should document shared decision-making when discontinuing screening in patients with limited life expectancy.

Regulatory and Compliance Considerations for AWV Billing

Medicare Documentation Requirements

CMS requires that the medical record for every AWV contain all mandated components in sufficient detail to support the billed code. Auditors look for:

• A completed, signed HRA
• Evidence of cognitive and depression screening with documented results and tool names
• A written, individualized prevention plan is furnished to the patient
• Medication reconciliation
• Provider signature and credentials

Templated notes that auto-populate identical content across visits raise red flags during audits. Every AWV record should reflect patient-specific findings and recommendations.

Audit context: According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the overpayment rate for AWVs (including subsequent visits billed under G0439) was 24.5%, with a projected overpayment amount of $307.5 million. This underscores the importance of complete and accurate documentation.

Staying Current with Annual Coding Updates

CMS updates the Medicare Physician Fee Schedule annually, which can affect AWV reimbursement rates, covered screening services, and documentation requirements. For example, the 2024 fee schedule introduced the SDOH assessment code (G0136), and the 2025 fee schedule allowed the G2211 complexity add-on code to be billed with AWVs. The 2026 fee schedule redefined G0136 from SDOH assessment to physical activity and nutrition assessment. Practices should review CMS transmittals and MLN Matters articles each year before January 1 to identify changes.

Common Compliance Pitfalls and Audit Triggers

The most frequent compliance mistakes with AWV billing include:

• Billing G0438 more than once per patient lifetime. The system may not always catch duplicates in real-time, but retrospective audits will identify overpayments.
• Missing HRA documentation. If the HRA is not in the medical record, the AWV claim is unsupported regardless of what the provider actually discussed.
• Upcoding E/M services on the same date. Billing a high-level E/M (99215) alongside an AWV without documentation supporting a separately identifiable, complex problem invites scrutiny.
• Failing to meet the 12-month interval. Billing an AWV before the first day of the eligible calendar month results in denial. Use scheduling systems that flag the earliest eligible date.
• Not billing G0444 separately with G0439. Depression screening is bundled into G0402 and G0438, but is separately billable with G0439. Missing this loses legitimate revenue on every subsequent AWV.
• Using AWV codes for telehealth without proper documentation. CMS covers AWVs via telehealth, but verify current modifier and place-of-service requirements. As of 2025, CMS confirmed it pays for G0438 and G0439 when provided via telehealth.

How to Prepare Patients for an Annual Wellness Visit

You can prepare patients for an Annual Wellness Visit (AWV) by communicating clearly before the appointment, educating them on what the visit includes and excludes, telling them exactly what to bring, and setting firm expectations that the AWV is preventive planning, not a problem-focused visit.

Pre-visit Communication and Patient Education

Patient confusion is the single biggest barrier to AWV completion. Most Medicare beneficiaries do not understand what an AWV is or why it differs from a regular checkup.

Effective practices send a letter, patient portal message, or phone call at least two weeks before the scheduled AWV explaining three things: what the visit includes, what it does not include (no full physical exam), and what to bring. Clear communication reduces same-day complaints and prevents patients from expecting services the AWV does not cover.

What Patients Should Bring to the Appointment

Instruct patients to bring:

• A completed Health Risk Assessment (if sent in advance)
• Current list of all medications, including over-the-counter drugs and supplements, with dosages
• Immunization records or dates of last vaccines
• Names and contact information of all other healthcare providers
• Any screening results from outside facilities (mammograms, colonoscopy reports, bone density scans)
• Family medical history updates
• Advance directive documents, if they wish to discuss end-of-life planning

Setting Expectations: AWV vs. Problem-Based Visit

Front desk staff should explain during scheduling that the AWV is a planning visit, not a visit to address current symptoms. If the patient has active medical concerns, the practice should offer to schedule a separate problem-oriented appointment or inform the patient that both can occur on the same day with appropriate billing.

Example: James, a 70-year-old patient, schedules an AWV but arrives wanting to discuss his worsening back pain and a new skin lesion. The practice had not set expectations beforehand. The provider spends 40 minutes addressing James’s concerns and only 10 minutes on AWV components, resulting in incomplete AWV documentation. The claim is denied on audit. Had the practice communicated clearly before the visit, James could have scheduled a separate appointment for his concerns, or the provider could have structured the visit to fully complete both the AWV and a separately documented E/M encounter.

How Can AWVs Support Value-Based Care Programs?

Connecting AWVs to Care Management Enrollment

The AWV is the most efficient clinical touchpoint for identifying patients who qualify for care management programs. During the visit, the provider reviews chronic conditions, medications, functional limitations, and social needs, which are exactly the data points needed to determine eligibility for:

• Chronic Care Management (CCM, 99490/99491): Requires two or more chronic conditions expected to last at least 12 months. The AWV prevention plan can serve as the foundational care plan.
• Remote Patient Monitoring (RPM, 99453/99457/99458): Patients identified during the AWV with uncontrolled hypertension, diabetes, or weight management needs are strong RPM candidates.
• Principal Care Management (PCM, 99424/99425): For patients with a single high-risk chronic condition requiring focused management.

Practices that systematically use AWVs as a funnel for care management enrollment see measurable increases in both revenue and patient outcomes.

Important note: CMS has clarified that when an AWV is performed by a professional who does not have diagnosis and treatment in their scope of practice (i.e., someone who cannot bill E/M services), the AWV cannot serve as the initiating visit for care management services.

Closing Gaps in Care and Improving Quality Measures

AWVs directly address quality measure performance in MIPS (Merit-based Incentive Payment System) and ACO (Accountable Care Organization) contracts. During the AWV, providers can close care gaps by:

• Ordering overdue cancer screenings
• Updating immunization status
• Completing depression and cognitive screening (both tied to quality measures)
• Documenting tobacco cessation counseling
• Assessing and addressing fall risk (a key quality measure for patients 65 and older)

A single well-executed AWV can close three to five open quality gaps per patient.

AWV Considerations for FQHCs and RHCs

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) bill AWVs differently than private practices.

FQHCs must bill using HCPCS code G0468, which represents an FQHC visit that includes an IPPE or AWV and covers the typical bundle of per-diem services. FQHCs are reimbursed at their Prospective Payment System (PPS) rate rather than the Physician Fee Schedule. The standard AWV codes (G0402, G0438, G0439) should still be reported on the claim for tracking purposes alongside G0468.

In FQHC and RHC settings, the AWV must be provided by a practitioner meeting the facility’s visit definition: physician (MD or DO), nurse practitioner, physician assistant, or certified nurse midwife. Although auxiliary staff may complete many AWV elements under supervision, the qualifying practitioner must be involved in the visit.

FQHCs that serve large Medicare populations often underutilize AWVs because their sliding fee scale patients are accustomed to problem-focused visits. Training front desk and clinical staff to identify and schedule AWV-eligible patients can significantly increase both preventive care delivery and per-visit revenue.

Final Words

Medicare Annual Wellness Visits play a critical role in preventive care and long-term patient outcomes, but their value depends on accurate coding and complete documentation. Understanding when to use G0402, G0438, and G0439 ensures compliance with CMS guidelines while maximizing reimbursement opportunities.

Providers who implement structured workflows, verify eligibility timelines, and capture all required components can reduce claim denials and audit risk. A well-executed AWV not only supports revenue integrity but also strengthens care planning, closes quality gaps, and aligns practices with value-based care initiatives.