Medicare Annual Wellness Visits create an important opportunity for primary care practices to identify health risks, establish a personalized prevention plan, and coordinate preventive services. However, selecting the wrong code or misunderstanding patient eligibility can lead to avoidable claim denials.
The three principal Medicare wellness visit codes are G0402, G0438, and G0439. Although these services are related, they are not interchangeable. Each code applies to a different stage of the patient’s Medicare coverage.
This guide explains the annual wellness visit CPT codes, eligibility requirements, documentation standards, modifier rules, and common billing mistakes primary care practices should understand in 2026.
For correct modifier placement and documentation requirements, review our annual wellness visit Modifier 25 billing guide.
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Annual Wellness Visit CPT Codes at a Glance
Medicare uses the following HCPCS codes for its preventive wellness visits:
- G0402: Initial Preventive Physical Examination, commonly called the “Welcome to Medicare” visit
- G0438: Initial Annual Wellness Visit
- G0439: Subsequent Annual Wellness Visit
Despite commonly being called annual wellness visit CPT codes, these are technically HCPCS Level II codes.
The correct code depends primarily on when the patient’s Medicare Part B coverage began and whether the patient previously received an Initial Preventive Physical Examination or Annual Wellness Visit.
G0402: Welcome to Medicare Visit
G0402 represents the Initial Preventive Physical Examination, or IPPE. Medicare permits this once-in-a-lifetime service during the first 12 months of a beneficiary’s Medicare Part B coverage.
The G0402 visit may include:
- Review of medical and social history
- Measurement of height, weight, body mass index, and blood pressure
- Assessment of functional ability and safety
- Review of potential depression risk
- Review of preventive services
- Education, counseling, and appropriate referrals
- Development of a written preventive-services plan
- Visual-acuity screening
- Certain electrocardiogram services when appropriate
G0402 is not a comprehensive routine physical examination. Its required components are determined by Medicare’s IPPE guidelines.
If the patient has been enrolled in Medicare Part B for longer than 12 months and did not receive the IPPE, the opportunity to bill G0402 has expired. The practice should then evaluate whether the patient qualifies for G0438.
Review the official CMS Initial Preventive Physical Examination requirements.
G0438: Initial Annual Wellness Visit
G0438 represents the patient’s first Annual Wellness Visit. It includes the creation of a personalized prevention plan of service.
A patient may generally qualify for G0438 when:
- The patient is no longer within the first 12 months of Medicare Part B coverage
- The patient has not received G0402 during the previous 12 months
- The patient has never received G0438
- The patient has not received another Annual Wellness Visit during the applicable 12-month period
G0438 is billed only once during the patient’s lifetime. It should not be used every year simply because the patient is new to the practice.
This distinction is critical: G0438 means the patient’s first Medicare Annual Wellness Visit—not the patient’s first wellness visit with a particular provider.
A practice that does not verify Medicare preventive-service history may incorrectly bill G0438 for a patient who received the service from another provider.
G0439: Subsequent Annual Wellness Visit
G0439 represents subsequent Annual Wellness Visits after the patient has received an initial G0438.
During a subsequent visit, the provider updates the patient’s health-risk information and personalized prevention plan. G0439 may generally be reported once every 12 months when eligibility requirements are satisfied.
The service may include updating:
- Medical and family history
- Current providers and suppliers
- Medications and supplements
- Measurements and health-risk information
- Cognitive assessment information
- Screening schedule
- Risk factors and health conditions
- Personalized health advice
- Referrals to preventive services and programs
Do not automatically bill G0439 once every calendar year. Medicare eligibility is based on the required time interval, not merely a change from one calendar year to another.
CMS states that G0438 or G0439 can only be billed once during a 12-month period. Review the current CMS Annual Wellness Visit guidance.
G0402 vs G0438 vs G0439
| Code | Service | General Timing | Frequency |
|---|---|---|---|
| G0402 | Initial Preventive Physical Examination | First 12 months of Part B coverage | Once per lifetime |
| G0438 | Initial Annual Wellness Visit | After the initial Part B period and when eligibility requirements are met | Once per lifetime |
| G0439 | Subsequent Annual Wellness Visit | After the initial AWV and required interval | Once per eligible 12-month period |
The patient’s eligibility history should be verified before the appointment whenever possible. A provider cannot reliably choose among these annual wellness visit CPT codes based only on the patient’s age or statement that the visit is “annual.”
Is an Annual Wellness Visit the Same as an Annual Physical?
No. A Medicare Annual Wellness Visit is not the same as a comprehensive annual physical examination.
The Annual Wellness Visit is designed to:
- Assess health risks
- Establish or update a prevention plan
- Review preventive-service needs
- Identify potential safety or functional concerns
- Support health promotion and disease prevention
It does not automatically include every examination or laboratory service that may be associated with a traditional physical.
Patients may reasonably believe they are receiving a complete physical because the appointment is called a “wellness visit.” Practices should explain the scope of the service before the appointment and identify any additional services that may create cost-sharing.
Clear scheduling language and patient communication can prevent confusion after the claim is processed.
Required Annual Wellness Visit Documentation
Complete documentation should demonstrate that all applicable components of the billed service were performed.
Health-Risk Assessment
The patient should complete or participate in a health-risk assessment containing the information required by Medicare. The assessment may address:
- Demographic information
- Self-assessment of health
- Psychosocial risks
- Behavioral risks
- Activities of daily living
- Instrumental activities of daily living
The information should be documented, reviewed, and incorporated into the prevention plan.
Medical and Family History
The record should include or update relevant medical and family history, including illnesses, hospitalizations, surgeries, allergies, and other clinically important information.
Current Providers and Medications
Document the patient’s current healthcare providers and suppliers. The medication list should include prescription medications, over-the-counter products, vitamins, and supplements when applicable.
Routine Measurements
Applicable measurements may include:
- Height
- Weight
- Body mass index
- Blood pressure
- Other measurements considered appropriate based on the patient’s history
Cognitive Assessment
The provider should assess for potential cognitive impairment using direct observation and available information from the patient, family members, caregivers, or others when appropriate.
Screening and Prevention Schedule
Develop or update a written screening schedule based on the patient’s age, sex, medical history, risk factors, and Medicare preventive-service recommendations.
Personalized Health Advice
The record should reflect appropriate health advice, education, counseling, or referrals based on the patient’s identified risks.
A checklist can support the workflow, but a checked box alone may not demonstrate the substance of the service. Documentation should show that the required elements were meaningfully addressed.
Can an Office Visit Be Billed With an Annual Wellness Visit?
A medically necessary evaluation and management service may be billed on the same date as an Annual Wellness Visit when the additional work is significant, separately identifiable, and supported by the documentation.
Examples may include evaluating a new complaint, managing an uncontrolled chronic condition, or making a treatment decision beyond the normal scope of the wellness visit.
The provider may report an appropriate office or outpatient E/M code, such as 99213 or 99214, when the documented medical decision-making or total time supports that service.
Modifier 25 is generally appended to the E/M code—not the wellness code—to indicate that the additional E/M service was significant and separately identifiable.
For example:
- G0439 for the subsequent Annual Wellness Visit
- 99214-25 for a separately documented, medically necessary office visit
The record should clearly distinguish the wellness components from the problem-oriented E/M work.
Simply reviewing stable conditions as part of the wellness visit does not automatically justify an additional office-visit code. Overusing modifier 25 can create audit exposure, while failing to report a legitimately separate service can result in lost revenue.
Can G2211 Be Billed With an Annual Wellness Visit?
G2211 is an add-on code associated with certain office or outpatient E/M services involving ongoing, longitudinal care or management of a serious or complex condition.
G2211 is not reported by itself and is not added directly to G0402, G0438, or G0439. It must be connected to an eligible office or outpatient E/M base code.
Under current Medicare policy, G2211 may be payable when an eligible office or outpatient E/M service is provided on the same day as an Annual Wellness Visit or another qualifying Part B preventive service, provided all requirements are satisfied.
A possible claim combination may include:
- G0439
- 99214-25
- G2211
However, the presence of an Annual Wellness Visit does not automatically make G2211 appropriate. Documentation must support the eligible E/M service and the continuing focal-point or ongoing-care relationship described by the code.
Practices should confirm current CMS and Medicare Administrative Contractor guidance before billing this combination.
Does Medicare Apply a Copay to an Annual Wellness Visit?
For a qualifying Medicare Annual Wellness Visit, the Part B deductible and coinsurance are generally waived.
However, patient cost-sharing may apply when additional services are performed that are not included in the preventive benefit.
For example, if a separately identifiable problem-oriented E/M service is billed with the Annual Wellness Visit, the E/M portion may be subject to the patient’s deductible or coinsurance.
Practices should avoid promising that the entire appointment will be free when additional diagnostic, treatment, or problem-oriented services may be provided.
Can an Annual Wellness Visit Be Performed Through Telehealth?
CMS currently permits payment for G0438 and G0439 when the services are provided through an eligible Medicare telehealth arrangement.
The provider must still complete and document the applicable Annual Wellness Visit requirements. The use of telehealth does not remove required service components or documentation standards.
Because Medicare telehealth rules, place-of-service requirements, modifiers, and geographic policies can change, practices should verify the current rules for the date of service before submitting the claim.
CMS maintains its official Medicare telehealth services list.
Common Annual Wellness Visit Billing Errors
Using G0438 for Every New Patient
G0438 is based on the patient’s Medicare wellness history—not whether the patient is new to the practice.
Billing Before the Patient Is Eligible
Submitting G0438 or G0439 before the required interval has passed can result in a frequency-related denial.
Confusing an AWV With a Routine Physical
Documenting only a general physical examination may fail to support the required Annual Wellness Visit components.
Missing the Health-Risk Assessment
An incomplete or undocumented health-risk assessment can weaken support for the billed service.
Billing an Unsupported Office Visit
An additional E/M code should not be reported when the provider only performed work already included in the wellness service.
Misusing Modifier 25
Modifier 25 belongs on the separately identifiable E/M service when its requirements are met. It should not be added automatically to every Annual Wellness Visit claim.
Failing to Provide a Prevention Plan
The personalized prevention plan is a core component of the Annual Wellness Visit.
Assuming January Starts a New Eligibility Period
Eligibility is not automatically restored on January 1. The practice should verify when the patient last received the relevant Medicare preventive service.
How to Reduce Annual Wellness Visit Denials
Primary care practices can reduce preventable denials by implementing a consistent workflow.
Verify Eligibility Before Scheduling
Check whether the patient received G0402, G0438, or G0439 and confirm the applicable service date.
Learn About Insurance Eligibility Verification
Use Code-Specific Documentation Templates
The G0402, G0438, and G0439 workflows should not use an identical template without accounting for the different requirements.
Separate Preventive and Problem-Oriented Documentation
When billing an E/M service on the same date, clearly document the separate medical necessity, assessment, decision-making, and plan.
Review Claims Before Submission
Confirm the selected code, eligibility, documentation, diagnosis information, modifier usage, and any additional services.
Track Denial Reasons
Monitor denials involving benefit maximums, frequency, eligibility, modifier 25, documentation, and medical necessity. Recurring denial patterns should result in corrective action.
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Frequently Asked Questions
What are the three Medicare wellness visit codes?
G0402 represents the Welcome to Medicare Initial Preventive Physical Examination. G0438 represents the initial Annual Wellness Visit, and G0439 represents subsequent Annual Wellness Visits.
Can G0438 be billed more than once?
No. G0438 represents the patient’s first Medicare Annual Wellness Visit and is generally payable only once during the beneficiary’s lifetime.
How often can G0439 be billed?
G0439 may generally be billed once during an eligible 12-month period. Practices should verify the patient’s previous wellness-service date before billing.
Can G0438 or G0439 be billed with 99213 or 99214?
Yes, when the provider performs a significant and separately identifiable, medically necessary E/M service beyond the Annual Wellness Visit requirements. The additional service must be properly documented, and modifier 25 is generally appended to the E/M code.
Does Medicare cover a routine annual physical?
Original Medicare generally does not cover a routine comprehensive physical examination as an Annual Wellness Visit. G0402, G0438, and G0439 have specific Medicare-defined components.
Can a patient receive G0402 and G0438 during the same year?
Medicare does not permit G0438 or G0439 within 12 months of G0402. Verify the applicable dates and eligibility before billing.
Can G2211 be billed with G0439?
G2211 may be reported with an eligible office or outpatient E/M service provided on the same day as an Annual Wellness Visit when current Medicare requirements are satisfied. It is not appended directly to G0439.
Is modifier 25 always required for an Annual Wellness Visit?
No. Modifier 25 is generally used only when a significant, separately identifiable E/M service is billed on the same date. It should not be added automatically to the wellness code.
Strengthen Your Primary Care Billing Workflow
Choosing among the annual wellness visit CPT codes requires more than knowing the patient’s age. The billing team must verify Medicare eligibility history, distinguish G0402 from G0438 and G0439, confirm that documentation supports the selected service, and correctly handle any separately identifiable E/M care.
A structured workflow can help primary care practices reduce frequency denials, prevent modifier errors, improve documentation consistency, and communicate potential patient responsibility more clearly.
The Ashez Group provides medical billing, coding review, insurance verification, denial management, and accounts-receivable support for primary care practices.
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Disclaimer: This article provides general educational information and does not replace current CMS, Medicare Administrative Contractor, payer, legal, coding, or compliance guidance. Billing requirements may change and should be verified for the applicable patient, payer, location, and date of service.
