Medicare Annual Wellness Visit Billing Codes
The correct codes for Medicare Annual Wellness Visit (AWV) are G0438 for the initial visit and G0439 for subsequent annual visits. 1
Understanding AWV Codes
Medicare has established specific Healthcare Common Procedure Coding System (HCPCS) codes for the Annual Wellness Visit:
- G0438: Initial Annual Wellness Visit - Used for the first AWV a Medicare beneficiary receives
- G0439: Subsequent Annual Wellness Visit - Used for all follow-up AWVs in subsequent years
Key Billing Information
The AWV is a preventive service introduced in 2011 as part of the Affordable Care Act and is available at no cost to Medicare beneficiaries 2. Unlike regular office visits that use CPT codes in the 99201-99215 range, the AWV uses these specific G-codes to indicate the comprehensive preventive assessment being performed.
Components of the AWV
The AWV includes several key elements that must be documented to support proper coding:
- Health risk assessment
- Review of medical and family history
- Development or update of a list of current providers and prescriptions
- Detection of cognitive impairment
- Personalized health advice and referrals as appropriate
- Establishment of a screening schedule for the next 5-10 years
Common Pitfalls to Avoid
Using CPT codes instead of G-codes: Unlike regular office visits, AWVs require the specific G-codes (G0438/G0439) rather than standard E&M codes 1.
Billing both an AWV and an E&M service: If you address a significant separate problem during an AWV, you may bill for both services using the -25 modifier with the E&M code, but documentation must support both services 1.
Confusing with the "Welcome to Medicare" visit: The Initial Preventive Physical Examination (IPPE or "Welcome to Medicare" visit) uses code G0402 and is different from the AWV. It can only be performed within the first 12 months of Medicare Part B enrollment.
Clinical Significance
The AWV represents an important opportunity for preventive care. Studies show that patients who receive AWVs have higher rates of preventive service utilization, including:
- 16.3% increase in depression screening
- 17.3% increase in alcohol misuse screening
- 10.7% increase in advance care planning 2
Despite these benefits, AWV utilization remains relatively low, with only 23% of eligible Medicare beneficiaries receiving this service as of 2016 3. Significant disparities exist in AWV utilization among different racial and ethnic groups, with lower rates among non-Hispanic Black and Hispanic/Latino beneficiaries 4, 3.
By using the correct codes and promoting this service, healthcare providers can help improve preventive care delivery and potentially reduce health disparities among Medicare beneficiaries.