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G0438 HCPCS Code: Medicare Initial Annual Wellness Visit Rules

Last Updated: June 16, 2026

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 ↗.

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2026 Medicare National Fee (G0438): Non-Facility (Office): $212.89 · Facility (Hospital): $212.89

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).

CodeDescriptionFrequency Limit
G0438Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visitOnce in a lifetime

Required Elements & Medical Necessity

Verify Medical Necessity

Don't risk a denial. See if your ICD-10 code is on the approved Medicare LCD list.

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.

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