Coding & Billing

AWV add-on codes: G0442, G0443, G0444, 99497, 99483, G0136

~10 min readBy Pelica Health teamPublished August 28, 2026Updated August 28, 2026Reviewed by Catherine Zhao

Short answer

Six Medicare services are separately payable on the same day as an Annual Wellness Visit: alcohol misuse screening (G0442) and counseling (G0443), depression screening (G0444), advance care planning (99497), the physical activity and nutrition risk assessment (G0136), and cognitive assessment and care planning (99483). G0444 is blocked with the initial AWV (G0438) and the Welcome to Medicare visit (G0402), because depression screening is already inside both. 99497 and G0136 need modifier 33 to keep the patient's cost sharing at zero. 99483 needs modifier 25 and always carries coinsurance.

What AWV add-on codes are

An Annual Wellness Visit pays about $174 for the initial visit (G0438) and about $138 for a subsequent one (G0439) in 2026. Several services that the AWV touches on but does not include are separately payable on the same date. Those are the add-on codes.

Five are worth knowing: alcohol misuse screening (G0442) and counseling (G0443), depression screening (G0444), advance care planning (99497), and the physical activity and nutrition risk assessment (G0136). A sixth, cognitive assessment and care plan (99483), is the one most practices bill wrong.

Two things decide whether an add-on works: whether Medicare already counts that work inside the AWV, and whether the patient ends up with a bill. Both answers differ code by code.

Patient cost for G0442, G0443 and G0444, and for 99497 or G0136 when they carry modifier 33 on the AWV claim.

4×

Times a year G0443 alcohol counseling is covered for a patient who screened positive.

6 months

Minimum interval between G0136 physical activity and nutrition assessments.

The six add-on codes at a glance

Payment figures are 2026 national non-facility averages, calculated from the CMS CY2026 Physician Fee Schedule Relative Value File (January release) and the $33.4009 conversion factor. Your locality will differ because of the geographic practice cost indices.

Code	Descriptor	Frequency	2026 national payment	Same day as the AWV?
G0442	Annual alcohol misuse screening, 5 to 15 minutes	Once a year	$18.70	Yes, no NCCI edit
G0443	Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes	4 times a year after a positive screen	$34.40	Yes, no NCCI edit
G0444	Annual depression screening, 5 to 15 minutes	Once a year	$18.70	With G0439 only. Blocked with G0438 and G0402
99497	Advance care planning, first 30 minutes	No limit, document a change each time	$86.84	Yes, add modifier 33
G0136	Standardized, evidence-based assessment of physical activity and nutrition, 5–15 minutes	Once every 6 months	$20.04	Yes, add modifier 33
99483	Assessment of and care planning for a patient with cognitive impairment	As clinically indicated	$292.93	NCCI edit, needs modifier 25. Usually its own visit

The descriptors above are the current CMS long descriptors from the July 2026 HCPCS Alpha-Numeric file. G0136's wording is new. CMS proposed deleting the code for CY2026, then kept it and rewrote it from an SDOH risk assessment into a physical activity and nutrition assessment. If your charge master still calls G0136 an SDOH screening, it is describing a descriptor that expired on December 31, 2025.

Which add-ons leave the patient with a bill

The AWV itself has no coinsurance and no deductible. The add-ons split into three groups.

Always free to the patient. G0442, G0443 and G0444 are covered preventive services under national coverage determinations 210.8 and 210.9. Coinsurance and deductible are waived whether or not an AWV happens that day.
Free only with modifier 33. CMS waives coinsurance and deductible on 99497 and on G0136 when the service is delivered the same day by the same AWV provider and billed with modifier 33 on the same AWV claim. Once per year for each. Deliver either one outside a covered AWV and cost sharing applies.
Never free. 99483 is not a preventive service. CMS states plainly that Part B coinsurance and deductible apply.

The modifier 33 rule has a failure mode worth knowing. If the AWV itself is denied for exceeding the once-per-year limit, CMS applies the deductible and coinsurance to the advance care planning that rode on it. A scheduling error eleven months after the last AWV turns a free conversation into a patient balance.

The G0444 trap

Depression screening is a required element of the initial AWV and of the Welcome to Medicare visit, so Medicare will not pay for it twice. Noridian, the Part B MAC for Jurisdictions E and F, puts it directly: "Depression Screening cannot be done the same time as the initial AWV or Initial Preventive Physical Exam (IPPE)."

The NCCI procedure-to-procedure edits back that up and go one step further. G0438 with G0444 and G0402 with G0444 both carry a modifier indicator of 0, which means no modifier will unbundle them. There is no workaround, and appending modifier 25 or 59 just produces a denial with extra steps.

G0439 is different. No active edit pairs the subsequent AWV with G0444, so depression screening is separately payable at every AWV after the first. Reviewing depression risk is still a required element of G0439, but administering a standardized screening instrument is separate work and Medicare pays for it.

Cognitive assessment: why 99483 usually needs its own visit

Detecting cognitive impairment is a required element of every AWV. 99483 is what happens next, and at roughly $293 it is by far the largest add-on on the list. It requires an independent historian, a functional assessment of activities of daily living, a standardized dementia staging instrument such as the FAST or the Clinical Dementia Rating, a high-risk medication review, neuropsychiatric screening, a safety evaluation covering the home and driving, and a written care plan.

CMS says you may bill 99483 separately from the AWV. NCCI, however, pairs 99483 with G0402, G0438 and G0439 as mutually exclusive procedures with a modifier indicator of 1, so the claim needs modifier 25 to get through. Noridian's instruction is the practical version: if you perform the AWV and the cognitive assessment in the same visit, add modifier 25.

Most practices schedule it separately anyway, and the reason is not the edit. 99483 also has a modifier-0 edit against 99497 and 99498, because advance care planning is one of its required elements and cannot be billed twice. Stacking a 50-minute cognitive workup onto a wellness visit that already ran long is how the documentation ends up thin enough to fail an audit.

Where modifier 25 actually goes

Modifier 25 belongs on a significant, separately identifiable evaluation and management service, not on a preventive screening code. CMS instructs practices to report the office E/M code (99202–99205 or 99211–99215) with modifier 25 when a problem is addressed alongside the AWV. NCCI pairs the AWV codes with the office E/M codes at modifier indicator 1, so modifier 25 is what unlocks payment for both.

The screening add-ons are a different story. G0442, G0443 and G0136 have no active NCCI edits against the AWV codes at all, so no unbundling modifier is needed. 99497 and G0136 take modifier 33, which is about cost sharing rather than bundling. And 99483 takes modifier 25 because it is an E/M-level service.

One quiet edit catches teams that add a PHQ-9 to the wellness visit: 96127, brief emotional or behavioral assessment, is bundled into both G0438 and G0439 at modifier indicator 0. It is never separately payable with an AWV. Neither is 97802, the initial medical nutrition therapy assessment.

Common mistakes

What goes wrong	Why it fails
G0444 billed with G0438 or G0402	Modifier indicator 0 edit. Depression screening is already inside both codes
99497 billed with an AWV but without modifier 33	The waiver requires modifier 33 on the same claim, same day, same provider. The patient gets a bill
99497 billed a second time in the year with no documented change	CMS allows repeat ACP but requires a documented change in health status or wishes
G0136 billed twice inside six months	The descriptor itself caps it at once every 6 months
G0136 billed with an E/M instead of the AWV	Payable, but the waiver does not apply and cost sharing lands on the patient
G0443 billed without a positive G0442 screen on file	Counseling is covered only for beneficiaries who screen positive
99483 billed with 99497 on the same day	Modifier indicator 0. Advance care planning is a required element of 99483
96127 added for the PHQ-9 done during the AWV	Bundled into G0438 and G0439 with no modifier override
Modifier 25 appended to G0442 or G0444	Screening codes are not E/M services. There is no edit to override

How Pelica handles the AWV visit

Add-ons get missed for a boring reason. At the moment the patient is in the room, nobody can see which of the six they are due for, or which ones are already blocked by what somebody billed eleven months ago.

Pelica builds one live member record from claims, EHR, pharmacy, lab and ADT feeds, so the eligibility clocks are already resolved: last AWV date, whether it was G0438 or G0439, whether G0136 is inside its six-month window, whether a positive alcohol screen is on file. The Provider Network copilot puts that on the practice agenda before the visit instead of in a denial letter after it. At HealthCare Partners, that took weekly assignment prep from 8 hours to 15 minutes.

Related terms

AWV CPT codes covers G0438 and G0439 themselves, including the 12-month eligibility rule that governs every add-on on this page. G0402 is the Welcome to Medicare visit, which blocks both an AWV and G0444 for the first 12 months. Annual Wellness Visit covers the required elements the add-ons sit next to.

Sources

Frequently asked questions

Common questions about billing services alongside a Medicare Annual Wellness Visit in 2026.

What can you bill on the same day as a Medicare Annual Wellness Visit?

Alcohol misuse screening (G0442) and counseling (G0443), advance care planning (99497), and the physical activity and nutrition risk assessment (G0136) are all separately payable with either AWV code. Depression screening (G0444) is payable with the subsequent AWV (G0439) but not with the initial AWV (G0438) or the Welcome to Medicare visit (G0402). Cognitive assessment (99483) is payable with modifier 25, though most practices schedule it as its own visit. A problem-oriented office E/M is also payable with modifier 25.

Why can't G0444 be billed with G0438?

Depression screening is a required element of the initial Annual Wellness Visit and of the Welcome to Medicare visit, so Medicare will not pay for it twice. The NCCI procedure-to-procedure edits pair G0438 with G0444 and G0402 with G0444 at modifier indicator 0, which means no modifier can unbundle them. G0444 is separately payable with G0439, the subsequent AWV, because no edit exists for that pair.

When does 99497 advance care planning cost the patient nothing?

CMS waives both the Part B coinsurance and the deductible on advance care planning when it is delivered on the same day by the same AWV provider and billed with modifier 33 on the same AWV claim. The waiver applies once per year. Deliver advance care planning outside a covered AWV, or omit modifier 33, and the patient owes coinsurance and deductible. If the AWV is denied for exceeding the once-per-year limit, CMS applies cost sharing to the ACP as well.

Does 99483 cognitive assessment require a separate visit?

Not strictly, but the edits push that way. CMS says you may bill 99483 separately from the AWV, and Noridian instructs practices to add modifier 25 if the AWV and the cognitive assessment happen in the same visit. NCCI pairs 99483 with G0402, G0438 and G0439 as mutually exclusive at modifier indicator 1, so the modifier is required. 99483 also has a modifier indicator 0 edit against 99497 and 99498, because advance care planning is one of its required elements.

Which AWV add-on codes need modifier 25?

Only the E/M-level ones. Modifier 25 belongs on a significant, separately identifiable office E/M (99202 to 99205 or 99211 to 99215) billed alongside the AWV, and on 99483 when the cognitive assessment is done at the same visit. G0442, G0443 and G0136 have no active NCCI edits against the AWV codes, so they need no unbundling modifier. 99497 and G0136 take modifier 33 instead, which controls cost sharing rather than bundling.

What is G0136 in 2026?

G0136 is now the administration of a standardized, evidence-based assessment of physical activity and nutrition, 5 to 15 minutes, not more often than every 6 months. Through 2025 the same code was an SDOH risk assessment. CMS proposed deleting it for CY2026, then kept it with the rewritten descriptor. It is an optional element of the AWV, and coinsurance and deductible are waived when it is billed with modifier 33 on the same AWV claim by the same provider.

How often is alcohol misuse counseling covered?

G0442, the annual alcohol misuse screening, is covered once a year for all Medicare beneficiaries. G0443, brief face-to-face behavioral counseling, is covered four times a year for beneficiaries who screen positive, and must be furnished by a qualified primary care practitioner in a primary care setting. Both waive coinsurance and deductible. Counseling follows the Five A's structure: assess, advise, agree, assist, arrange.

Most missed add-ons are eligibility problems, not coding problems.

Pelica resolves every AWV clock on the live member record, then puts the eligible add-ons on the practice agenda before the visit. Provider network teams go from 8 hours of weekly assignment prep to 15 minutes.

Book a Demo → See the Provider Network copilot