What the AWV CPT codes are
The two codes for a Medicare Annual Wellness Visit are G0438 and G0439. G0438 covers the initial AWV, the first one a patient ever receives, and is billable once per lifetime. G0439 covers every AWV after that and is billable once per 12-month period. The Centers for Medicare and Medicaid Services (CMS) created both as preventive G-codes, not standard office-visit E/M codes.
The AWV is not a head-to-toe physical exam. It is a structured prevention and planning visit built around a Health Risk Assessment and a personalized prevention plan. G0438 sets that plan up for the first time. G0439 reviews and updates it each year after.
The codes carry no CPT-style component breakdown by time or complexity the way an E/M code does. You report one unit of G0438 or one unit of G0439 for the visit. The national average payment figures move a little each year with the Medicare Physician Fee Schedule and adjust by locality, so the roughly $174 for G0438 and roughly $138 for G0439 are starting points, not fixed amounts. The initial code pays more because it does more work: building the prevention plan from scratch takes longer than reviewing one that already exists.
G0438, G0439, G0402, and G0468
Four Medicare codes get confused here, and only two of them are the AWV. G0438 and G0439 are the AWV. G0402 is the one-time Welcome to Medicare exam, and G0468 is a federally qualified health center code. Reaching for the wrong one is a common denial.
- G0438, the initial AWV. A patient's first AWV, billable once per lifetime. It creates the personalized prevention plan and all of its required components.
- G0439, the subsequent AWV. Every AWV after the initial one, billable once per 12-month period. It reviews and updates the plan G0438 created.
- G0402, the Initial Preventive Physical Examination (IPPE), known as the Welcome to Medicare visit. It is available only within the first 12 months of Part B enrollment. It is not an AWV, and you cannot bill an AWV within 12 months of G0402.
- G0468, a federally qualified health center visit that includes an IPPE or an AWV. It is used for FQHC billing rather than the standard physician fee schedule.
Who is eligible and how the timing works
A patient qualifies for the initial AWV (G0438) once they have had Medicare Part B for at least 12 months. After that, Medicare pays for one AWV every 12 months, billed as G0439. The visit carries no coinsurance and no deductible when billed correctly, and Medicare also covers it via telehealth.
Medicare counts eligibility by calendar month, not by exact date. A patient becomes eligible again on the first day of the same month the following year. A patient who had an AWV on March 15, 2025 is eligible again on March 1, 2026, not March 15. Billing even a few days early triggers a denial, so scheduling into the following month is the safe rule.
One more timing rule ties back to G0402. A patient in their first 12 months of Part B can receive the Welcome to Medicare IPPE, but an AWV cannot be billed within 12 months of that IPPE. A new Medicare patient therefore moves through a sequence: the IPPE (G0402) inside the first year if they want it, then the initial AWV (G0438) once they pass 12 months of Part B, then a subsequent AWV (G0439) every year after. The most frequent denials come from billing a second AWV inside the same 12-month window or billing G0438 a second time when the patient has already had one.
What the AWV must include
Medicare requires a defined set of components for the AWV. G0438 creates them for the first time, and G0439 reviews and updates them. Missing a required element is a documentation risk if the visit is later audited. The required components are:
- A Health Risk Assessment (HRA).
- Medical and family history.
- A current list of the patient's providers and suppliers.
- Height, weight, body mass index (BMI), and blood pressure.
- Detection of any cognitive impairment.
- Review of depression and other mood-disorder risk.
- Review of functional ability and safety, including fall risk, activities of daily living, hearing, and home safety.
- A written screening schedule, a checklist covering the next 5 to 10 years.
- Personalized health advice and referrals.
- Voluntary advance care planning.
The difference between the two codes is in the verb. G0438 establishes each of these elements: the first Health Risk Assessment, the first written screening schedule, the first prevention plan. G0439 updates them. The history is refreshed, the vitals retaken, the screening checklist moved forward, and any new risks noted. Documenting the update is what makes a subsequent AWV billable; reusing last year's note without evidence of a current review will not hold up.
The AWV is also where a great deal of clinically relevant detail surfaces once a year. That makes it the natural moment to confirm a patient's active chronic conditions, which matters for both the care plan and accurate risk adjustment.
Billing an AWV with a problem visit on the same day
You can bill an AWV and a problem-oriented office visit on the same day. The AWV is a preventive service. If the patient also has a separately identifiable problem addressed during the encounter, append modifier 25 to the E/M code. The two are not bundled together.
This matters because patients rarely arrive with nothing else going on. A diabetic patient there for their AWV may also need a medication reviewed and adjusted. The AWV (G0438 or G0439) covers the prevention and planning work, and the E/M with modifier 25 covers the problem evaluation and management. Documenting both clearly, as two distinct pieces of work, is what supports payment for each.
One detail to watch: while the AWV has no patient cost-sharing, the problem-oriented E/M does. The deductible and coinsurance that do not apply to the AWV can apply to the separate office visit, so a patient who came in expecting a free wellness visit may still see a charge for the problem that was managed alongside it. Setting that expectation up front avoids a billing complaint after the claim posts.
How Pelica handles AWV-driven risk capture
The AWV is the single best recurring opportunity to review and re-document chronic conditions, because every component is captured once a year for the whole panel. Conditions that map to Hierarchical Condition Categories (HCCs) have to be documented every calendar year to count toward a member's RAF score, and the AWV is where that review naturally happens. Most platforms show you a list of members due for an AWV. Pelica does the coordination.
Pelica unifies claims, EHR, pharmacy, lab, and ADT data into one live member record, then puts a Risk Adjustment copilot next to the team. It surfaces the members due for an AWV, the chronic conditions likely to need recapture, and the supporting evidence, then schedules the visit and follows up until it is done. At HealthCare Partners, the largest IPA in the country, that takes risk-adjustment coordination from 30 minutes to 3 minutes per member and lets the same team cover two to three times as many members. The output is documentation that holds up against CMS-HCC V28 without adding headcount.
Related terms
The AWV connects to several related topics. See Annual Wellness Visit for the visit itself, AWV ICD-10 for the diagnosis code to report on the claim, and RAF for how documented conditions set a member's risk score.