The Medicare Annual Wellness Visit (AWV) is a massive revenue driver for primary care practices, but it is also a massive audit target. The Initial AWV is billed using HCPCS code G0438.
When to Bill G0438
G0438 can only be billed once in a lifetime per Medicare beneficiary. It must be performed after the patient has been enrolled in Medicare Part B for longer than 12 months (otherwise, they qualify for the IPPE / G0402).
| Code | Description | Frequency Limit |
|---|---|---|
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit | Once in a lifetime |
Required Elements & Medical Necessity
G0438 is a preventive service, meaning it does not require a sick diagnosis. Use Z00.00 (Encounter for general adult medical examination without abnormal findings). You MUST administer and document a Health Risk Assessment (HRA), establish a list of current providers, and review the patient's medical and family history.
NCCI Edits: Billing with a Sick Visit
If you perform a significant, separately identifiable sick visit (E/M) on the same day as the G0438, you can bill both! Append Modifier 25 to the E/M code (e.g., 99213-25). Run an NCCI check to ensure no other preventive codes are overlapping.