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

Quick Answer

The main Medicare Annual Wellness Visit codes are G0402, G0438, and G0439.

The most common mistake is treating an Annual Wellness Visit like a routine annual physical. It is not the same service. Medicare describes the yearly wellness visit as a visit to “develop or update your personalized plan” to help prevent disease and disability. Medicare.gov

For providers, the coding decision usually comes down to three questions:

1. Is the patient in the first 12 months of Medicare Part B?
2. Has the patient already received an initial Annual Wellness Visit?
3. Is the visit preventive planning only, or was a separate problem-oriented issue evaluated and managed?

This guide explains how to choose the right code, what to document, and where billing mistakes usually happen.

G0402, G0438 and G0439 Code Descriptions and 2026 Payment

These are the official HCPCS descriptors, which is the wording most coders are looking for when they search a code.

The payment figures are approximate national non-facility averages for 2026. Your rate depends on your locality, so check it in the CMS Physician Fee Schedule lookup before you build a budget around it.

Notice the gap between the two AWV codes. The initial visit pays about $36 more than the subsequent one.

That’s why code selection matters even when both claims would be paid: a practice that bills G0439 out of habit for a patient who has never had an initial AWV is under-coding the visit and leaving the patient’s history wrong for next year.

The Welcome to Medicare visit can also include a once-in-a-lifetime screening electrocardiogram, billed with its own codes: G0403 (12-lead ECG with interpretation and report), G0404 (tracing only) or G0405 (interpretation and report only).

The patient pays nothing for G0402, G0438 or G0439 when the provider accepts assignment, according to Medicare.gov. Separate services added on the same day can still carry a deductible or coinsurance.

Is There an Annual Wellness Visit CPT Code by Age?

No. Medicare’s wellness codes don’t change with age.

Eligibility runs on how long the patient has had Part B, so a 52-year-old on Medicare because of a disability uses exactly the same G0402, G0438 and G0439 rules as a 75-year-old.

The age-based codes people find when they search this are the CPT preventive medicine codes. Commercial plans use them for an annual physical, and Original Medicare generally doesn’t cover that kind of routine exam.

So a Medicare patient who turns 65 doesn’t move to 99387 or 99397 for their wellness visit. They stay on the AWV codes, and a routine physical billed with 99397 is usually the patient’s responsibility under Original Medicare.

What Is a Medicare Annual Wellness Visit?

A Medicare Annual Wellness Visit, often called an AWV, is a preventive visit focused on risk assessment, health planning, and care coordination. It is designed to help the provider build or update a personalized prevention plan for the patient.

An AWV usually includes:

• Health risk assessment
• Review of medical and family history
• Medication and provider list review
• Height, weight, blood pressure, and other routine measurements
• Cognitive impairment screening
• Depression, fall risk, and functional ability screening when appropriate
• Review of preventive services due
• Personalized prevention plan
• Advance care planning discussion when appropriate

CMS explains that the AWV includes a health risk assessment and a personalized prevention plan. CMS Annual Wellness Visit

The key point: an AWV is not a head-to-toe exam. It is a structured preventive planning visit.

Annual Wellness Visit vs Annual Physical

Patients often ask for an “annual physical,” but Medicare’s Annual Wellness Visit is different.

Medicare states that the yearly wellness visit is not a physical exam. That distinction matters because billing a non-covered routine physical as a covered AWV can create compliance risk. Medicare.gov

When to Use G0402: Welcome to Medicare Visit

Use G0402 for the Initial Preventive Physical Examination, commonly called the Welcome to Medicare visit.

Use G0402 when:

• The patient is within the first 12 months of Medicare Part B enrollment
• The patient has not already received the Welcome to Medicare visit
• The visit meets the required preventive visit elements

CMS describes G0402 as the initial preventive physical examination and lists it as a once-per-lifetime Medicare wellness service. CMS Medicare Wellness Visits

Do not use G0402 when:

• The patient has had Medicare Part B for more than 12 months
• The patient is coming for a subsequent yearly wellness visit
• The service was a problem-focused evaluation only
• The patient received a routine physical that does not meet Medicare’s preventive visit rules

Practical example

A patient enrolled in Medicare Part B six months ago and schedules a preventive visit. The provider reviews history, risk factors, preventive services due, and creates the required plan. If the documentation supports the service, G0402 is the correct code.

When to Use G0438: Initial Annual Wellness Visit

Use G0438 for the patient’s first Annual Wellness Visit after the Welcome to Medicare window has passed.

Use G0438 when:

• The patient has had Medicare Part B for more than 12 months
• The patient has not received an initial AWV before
• The service includes the required AWV elements

G0438 is not used every year. It is for the first AWV only.

Do not use G0438 when:

• The patient is still in the first 12 months of Medicare Part B
• The patient already had an initial AWV
• The visit is a subsequent AWV
• The visit is only a problem-oriented encounter

Practical example

A patient has been enrolled in Medicare Part B for three years but has never completed an AWV. The practice performs the required assessment and creates a personalized prevention plan. In this case, G0438 is the correct code.

When to Use G0439: Subsequent Annual Wellness Visit

Use G0439 for a subsequent Medicare Annual Wellness Visit.

Use G0439 when:

• The patient already received an initial AWV
• At least 12 months have passed since the last AWV
• The provider updates the patient’s risk assessment and prevention plan

G0439 is the code many practices use most often because it applies to ongoing yearly AWVs after the initial AWV has already been completed.

Do not use G0439 when:

• The patient has never had an initial AWV
• Fewer than 12 months have passed since the last AWV
• The visit does not include the required AWV documentation

Practical example

A patient completed an initial AWV last year. This year, the practice updates the health risk assessment, medication list, preventive screening schedule, and personalized prevention plan. If the timing requirement is met, G0439 is the correct code.

G0402 vs G0438 vs G0439

Here is the simplest way to choose the right Medicare wellness visit code:

If your team is unsure which code applies, check the patient’s Medicare Part B effective date and AWV history before the visit. Many claim problems start because the code was selected from habit rather than eligibility.

What Must Be Documented for an Annual Wellness Visit?

Good AWV documentation should show that the visit was more than a brief conversation. It should make the preventive planning work visible.

Document these elements clearly:

1. Health risk assessment

The health risk assessment should capture the patient’s self-reported health, psychosocial risks, behavioral risks, activities of daily living, and other preventive care indicators.

2. Medical and family history

Include past medical history, surgical history, family history, medications, allergies, supplements, and current providers involved in the patient’s care.

3. Routine measurements

Document height, weight, body mass index, blood pressure, and any other routine measurements required for the visit.

4. Cognitive and functional screening

The record should show that cognitive status and functional ability were reviewed when required. This may include fall risk, hearing, activities of daily living, and home safety.

5. Depression and behavioral risk review

Many AWVs include depression screening, alcohol use review, tobacco use review, nutrition counseling opportunities, and physical activity review.

6. Preventive service schedule

Create or update the patient’s screening and preventive service schedule. This may include vaccines, cancer screenings, cardiovascular risk review, diabetes screening, osteoporosis screening, and other age- or risk-based services.

7. Personalized prevention plan

The prevention plan is the center of the AWV. It should list risks identified during the visit and the next steps the patient and care team should take.

This is where many practices can improve. A generic note that says “preventive counseling provided” is weaker than a plan that clearly states what was reviewed, what is due, and what follow-up is needed.

Can You Bill an E/M Visit With an Annual Wellness Visit?

Sometimes, yes. But the documentation must support a separately identifiable problem-oriented service.

For example, during an AWV, a patient may raise a new issue such as uncontrolled blood pressure, worsening shortness of breath, medication side effects, or new pain. If the provider evaluates and manages that problem beyond the preventive AWV work, a separate E/M service may be appropriate.

In that case:

• The AWV code may be billed for the preventive service
• The problem-oriented E/M code may be billed separately when medically necessary
• Modifier 25 may be required on the E/M code
• Documentation must clearly separate the preventive AWV work from the problem-focused evaluation

Do not add an E/M code just because the visit took longer. Add it only when the record supports a distinct evaluation and management service.

Can G2211 Be Billed With G0439?

This is a common question because G2211 is used for visit complexity in certain longitudinal care relationships.

The safest answer is: do not assume it can be added automatically to an AWV. G2211 is tied to certain office or outpatient E/M visits, not to every preventive service. If a separately identifiable E/M service is performed on the same date as an AWV, billing teams should review current CMS guidance, payer rules, and documentation before adding G2211.

For practices managing complex chronic conditions, this is also a reminder that the AWV should not carry the entire care burden. Chronic care needs may be better supported through programs such as Chronic Care Management, Principal Care Management, or Advanced Primary Care Management.

AWV Codes and Common Add-On Services

An AWV can identify the need for other preventive or care-management services. Some may be furnished separately when requirements are met.

Common related services include:

If you offer remote care programs, the AWV can become a useful front door for identifying patients who need more structured support. For example, a patient with uncontrolled hypertension may benefit from Remote Patient Monitoring, while a patient with multiple chronic conditions may be a better fit for Chronic Care Management.

AWV Add-On Codes and Their 2026 Rules

Several services are billed on the same claim as the AWV. Each has its own rule, and one of them blocks several others.

Sources: First Coast Service Options AWV billing guidance for modifier 33, MedLearn’s summary of the CY 2026 final rule for G0136, and the CMS CY 2026 Physician Fee Schedule final rule (CMS-1832-F). Payer rules vary, so check your MAC’s guidance for anything not shown here.

FQHCs, RHCs, and Annual Wellness Visits

Federally Qualified Health Centers and Rural Health Clinics should pay close attention to AWV billing rules because payment methodology and claim submission can differ from standard physician office billing.

For FQHCs and RHCs, the key questions are:

• Is the patient eligible for the AWV?
• Was the required preventive service documented?
• Does the claim follow the correct billing method for the setting?
• Are additional preventive services separately payable or bundled?

Do not copy physician-office billing rules into FQHC or RHC workflows without checking current Medicare guidance.

Common Annual Wellness Visit Coding Mistakes

Mistake 1: Using G0439 when the patient needs G0438

G0439 is for subsequent AWVs. If the patient has never had an initial AWV, G0438 is usually the correct code.

Mistake 2: Billing an AWV as an annual physical

The AWV is a preventive planning visit. A routine physical is different and may not be covered by Original Medicare.

Mistake 3: Missing the 12-month rule

G0439 generally requires that at least 12 months have passed since the previous AWV.

Mistake 4: Weak prevention-plan documentation

The prevention plan should be specific enough that another clinician can understand what was reviewed and what follow-up is recommended.

Mistake 5: Adding an E/M code without separate documentation

If a problem-oriented E/M service is billed on the same day, the note must support it separately from the AWV.

Mistake 6: Forgetting patient communication

Patients often believe the AWV is a physical. Explain the purpose before the visit so they know what to expect and what may create additional cost-sharing.

How Practices Can Improve AWV Workflows

The best AWV programs are built before the patient enters the room.

Before the visit

• Confirm Medicare eligibility and prior AWV history
• Send the health risk assessment ahead of time
• Review preventive services due
• Prepare medication and provider-list review
• Identify open care gaps

During the visit

• Confirm history and risk factors
• Complete required screenings
• Review medications and care team
• Discuss preventive services
• Create or update the prevention plan
• Identify patients who may need CCM, PCM, RPM, or other follow-up programs

After the visit

• Close preventive care gaps
• Schedule follow-up services
• Route patients into appropriate care-management programs
• Track documentation completeness
• Review billing accuracy

HealthArc helps healthcare organizations connect preventive care, care coordination, and remote care workflows through one digital health platform. For providers managing Medicare populations, that connection matters because an AWV often reveals care gaps that should not be left sitting in a note.

FAQs About 2026 Medicare Annual Wellness Visit CPT Codes

Final Takeaway

Annual Wellness Visit coding is simple only when the workflow is clean.

Use G0402 for the Welcome to Medicare visit, G0438 for the first Annual Wellness Visit, and G0439 for subsequent Annual Wellness Visits. Then make sure the documentation proves the service: health risk assessment, screenings, preventive service schedule, and a personalized prevention plan.

For providers, the real opportunity is bigger than the claim. A well-run AWV program can uncover care gaps, identify patients who need chronic care support, and connect preventive planning with ongoing care management.