2026 Medicare Annual Wellness Visit CPT Codes: G0402, G0438, G0439

Medicare uses three main HCPCS codes for 2026 Annual Wellness Visits (AWVs): G0402 for the “Welcome to Medicare” exam, G0438 for the first Annual Wellness Visit, and G0439 for every subsequent Annual Wellness Visit once a year after that. These wellness visits are preventive—not head‑to‑toe physicals—and they focus on health risk assessment, screening, and a personalized prevention plan for Medicare beneficiaries.

What is a Medicare Annual Wellness Visit?

A Medicare Annual Wellness Visit is a Part B preventive benefit that helps clinicians identify health risks, update medical history, and create a personalized prevention plan for eligible patients. Unlike a traditional annual physical, the AWV emphasizes a structured health risk assessment, screening schedule, and counseling rather than a comprehensive physical exam.

For practices, AWVs support value‑based care by closing gaps in preventive services, improving patient engagement, and generating reliable, recurring revenue when coded correctly. For patients, most AWVs are covered at 100% by Medicare, meaning no deductible or coinsurance when the visit is billed under the correct AWV CPT/HCPCS codes.

Key AWV CPT/HCPCS Codes for 2026: G0402, G0438, G0439

Medicare wellness visit coding revolves around three core HCPCS Level II codes that are often colloquially referred to as “CPT codes for annual wellness visits.” Understanding when each is allowed is critical to avoid denials and maximize reimbursement.

G0402 – Initial Preventive Physical Examination (IPPE, “Welcome to Medicare”)

• One‑time benefit, only during the first 12 months after Part B enrollment.
• Focus: baseline health history, vitals, vision screening, and orientation to preventive benefits.

G0438 – Initial Annual Wellness Visit

• First AWV after at least 12 months of Part B coverage (and after the IPPE window has passed).
• Can only be billed once in a patient’s lifetime as the “initial” AWV.

G0439 – Subsequent Annual Wellness Visit

• Used for every AWV after G0438, no more than once every 12 months.
• Requires updating, rather than recreating, the full health risk assessment and prevention plan.

These HCPCS codes are the real “annual wellness visit CPT codes” Medicare recognizes, and correct use ensures your claims are not rejected for duplicate or out‑of‑sequence billing.

Annual Wellness Visit vs Annual Physical: Why the Code Matters

One of the most common sources of confusion is between a Medicare Annual Wellness Visit (coded with G0438 or G0439) and a comprehensive annual physical exam (coded with 99381–99397 in CPT). Medicare does not cover routine annual physical CPT codes for adults, so billing a 9939x code to Medicare as a “wellness visit” typically results in denials or patient liability.

In practical terms:

• Use AWV HCPCS codes (G0438, G0439) when the visit meets Medicare’s wellness visit requirements.
• Use preventive visit CPT codes (9938x–9939x) for non‑Medicare payers that cover full physicals, following each payer’s policy.

This distinction is at the core of the search intent behind queries like “annual wellness visit CPT code” and “CPT code for annual physical.”

When to Use G0402, G0438, and G0439

To choose the right annual wellness visit CPT code, think in terms of timing and eligibility.

Use G0402 (IPPE) when:

• The patient is within the first 12 months of Medicare Part B enrollment.
• You are performing the one‑time “Welcome to Medicare” exam, which is technically not an AWV but often part of the same preventive workflow.

Use G0438 (Initial AWV) when:

• At least 12 months have passed since Part B enrollment and the patient has not yet had an AWV.
• You are performing the first official Medicare Annual Wellness Visit, including a full health risk assessment and prevention plan.

Use G0439 (Subsequent AWV) when:

• At least 12 months have passed since the last AWV (G0438 or G0439).
• You are updating, not recreating, the previous AWV’s data and prevention plan.

Only one AWV (G0438 or G0439) can be billed per beneficiary per 12‑month period, regardless of how many providers they see.

Core Components of an AWV (What Must Be Documented)

Medicare lays out specific required elements for an AWV that must be performed and documented to support the CPT code for an annual wellness visit. For both G0438 and G0439, clinicians should ensure the visit includes:

• A standardized Health Risk Assessment (HRA).
• Review and update of medical and family history.
• List of current providers and suppliers involved in the patient’s care.
• Routine measurements such as height, weight, blood pressure, and BMI.
• Cognitive impairment assessment and depression risk evaluation.
• Review of functional status, fall risk, safety at home, and sensory issues.
• Personalized health advice and a written, time‑bound screening schedule.
• Optional advance care planning discussion if the patient agrees.

For G0439, these elements are updated rather than completed from scratch, which is why subsequent visits are typically more streamlined.

Who Can Bill Annual Wellness Visit Codes?

Medicare allows some flexibility in who may furnish and bill for AWVs, provided services are within scope of practice and supervision rules. Eligible professionals include:

• Physicians (MD/DO)
• Nurse practitioners and physician assistants
• Certified nurse specialists and nurse midwives
• Other qualified staff (such as health educators and dietitians) working under the direct supervision of a physician, according to CMS rules.

This flexibility allows practices to design efficient workflows, delegating much of the HRA and screening work to clinical staff while billing under a physician or qualified practitioner’s NPI.

Coding Annual Wellness Visits vs Problem‑Oriented E/M on the Same Day

Medicare permits AWVs to be billed on the same day as a problem‑oriented evaluation and management (E/M) visit when medically necessary. In that case:

• Bill the AWV code (G0438 or G0439) for the preventive portion.
• Bill the appropriate E/M CPT code with modifier ‑25 to indicate a significant, separately identifiable service beyond the preventive visit.

The AWV remains fully covered, while the problem‑oriented E/M service may be subject to copayment and deductible. Clear, separate documentation for each service is essential to withstand audits.

Additional Codes Commonly Billed With AWVs

Many organizations pair AWVs with other preventive or care‑management services to enhance clinical value and revenue. Common add‑on codes include:

• Advance Care Planning – 99497 (first 30 minutes) and 99498 (each additional 30 minutes)
  • Face‑to‑face discussion of advance directives and future care preferences; when billed with AWV, the patient’s cost‑sharing may be waived.
• Social Determinants of Health Assessment – G0136
  • 5–15 minutes of standardized SDOH screening covering issues like food, housing, and transportation barriers.
• Other preventive services such as depression screening (G0444), obesity counseling (G0447), and alcohol misuse screening/counseling (G0442, G0443) may be provided on the same date, subject to CMS bundling and coverage rules.

Designing AWV workflows to include these services where appropriate can turn one encounter into a comprehensive preventive care touchpoint.

FQHCs and AWV Billing

Federally Qualified Health Centers can bill for AWVs but must follow specific rules and add‑on codes. In addition to the standard AWV HCPCS codes, FQHCs may use code G0468 as a per‑visit payment code that reflects FQHC‑specific reimbursement.

For example, an FQHC might bill G0402 or G0438/G0439 plus G0468 to indicate the service is furnished in an FQHC setting. Exact payment rates vary and should be confirmed in the current Medicare Physician Fee Schedule or FQHC payment rules.

Annual Wellness Visit CPT Code – Quick Answers

What is the annual wellness visit CPT code for Medicare?

Medicare uses HCPCS codes G0438 for the initial Annual Wellness Visit and G0439 for subsequent Annual Wellness Visits.

Which CPT code is used for a Welcome to Medicare visit?

The “Welcome to Medicare” Initial Preventive Physical Examination uses HCPCS code G0402 during the first 12 months after Part B enrollment.

Is there a CPT code for a well visit or annual physical under Medicare?

Traditional adult annual physical codes (99381–99397) are preventive visit codes used by commercial payers and are not covered as routine annual physicals by Medicare.

What CPT code should be used for a wellness visit after the first year?

Once a patient has had G0438, use G0439 for each subsequent Annual Wellness Visit once every 12 months.

What Is the Difference Between G0439 and 99397?

G0439 – Subsequent Annual Wellness Visit

• Medicare HCPCS code used only for beneficiaries who have already had the initial AWV (G0438).
• Focuses on updating the patient’s health risk assessment, medication list, and preventive screening schedule.
• Covered at 100% under Medicare Part B when eligibility criteria are met.

99397 – Periodic Comprehensive Preventive Exam (Established Patient, 65+ years)

• CPT code for a full preventive physical including comprehensive examination, often used by commercial payers.
• Medicare treats 99397 as a non‑covered routine physical and typically does not pay for this code.

In summary, G0439 is the correct code for a Medicare subsequent Annual Wellness Visit, while 99397 is a preventive physical code generally used for non‑Medicare plans and not for Medicare AWVs.

What Is CPT Code 99396 for an Annual Wellness Visit?

• 99396 is a CPT code for a periodic comprehensive preventive medicine visit for established patients aged 40–64 years.
• It is not a Medicare Annual Wellness Visit code and is typically used by commercial insurers when they cover adult preventive physicals.

For Medicare beneficiaries, the correct “wellness visit” codes are G0402 (IPPE), G0438 (initial AWV), and G0439 (subsequent AWV), not 99396.

How HealthArc Helps Streamline AWV Coding and Workflows

HealthArc helps practices implement scalable, compliant Annual Wellness Visit programs that integrate seamlessly with chronic care management, remote monitoring, and other value‑based initiatives. By digitizing health risk assessments, automating eligibility checks, and guiding staff through required elements, HealthArc can reduce the risk of denied AWV claims while increasing completion rates.

Paired with AWV‑centric tools—such as structured templates for G0438 and G0439, reminders for 12‑month intervals, and built‑in prompts for add‑on services like advance care planning—HealthArc enables teams to focus on patient care instead of chasing paperwork. This kind of infrastructure makes it easier for organizations to reliably capture the correct annual wellness visit CPT code on every eligible encounter and maintain accurate documentation for audits.

Common “Annual Wellness Visit CPT Code” Options

FAQs About 2026 Medicare Annual Wellness Visit CPT Codes