ICD-10 Code for Medicare Annual Wellness Visit
The Medicare Annual Wellness Visit does not require a specific ICD-10 diagnosis code for billing purposes; instead, it uses Medicare-specific G-codes (G0438 for initial visits and G0439 for subsequent visits) for procedural coding. 1
Understanding Medicare AWV Coding Structure
Medicare wellness visits operate differently from standard preventive care visits and require specific coding practices:
Medicare does not reimburse standard preventive care CPT codes (99381-99397) for wellness visits, requiring instead the use of G-codes G0438 and G0439. 1
G0438 is used for the initial Annual Wellness Visit (first AWV after becoming eligible for Medicare). 1
G0439 is used for subsequent Annual Wellness Visits (performed annually after the initial visit). 1
ICD-10 Codes That May Be Used
While the AWV itself doesn't require a diagnosis code, if specific conditions or screening results are documented during the visit, relevant ICD-10 codes may include:
- Z00.00 - Encounter for general adult medical examination without abnormal findings
- Z00.01 - Encounter for general adult medical examination with abnormal findings
- Z71.89 - Other specified counseling (can include exercise counseling, though not standalone billable). 2
- Z72.3 - Lack of physical exercise (exists but not recognized as standalone billable by most payers). 2
Common Billing Pitfalls to Avoid
Do not confuse G-codes with CPT codes: The CMS focuses on G-codes for Medicare-specific services like annual wellness visits rather than universally accepted CPT codes, which can create confusion. 2
When billing additional services on the same day as an AWV, use modifier 25 on the wellness visit code if a separate evaluation and management service is provided. 1
If the visit becomes complex and requires significant problem-focused evaluation beyond the wellness visit scope, an appropriate E/M code (99212-99215) may be billed in addition to the wellness visit code with modifier 25. 1
Clinical Context
The Medicare AWV was introduced in 2011 as part of the Affordable Care Act and focuses on health risk assessment, personalized prevention planning, and screening for cognitive impairment rather than comprehensive physical examinations. 1, 3 Utilization has increased from 8.1% in 2011 to 23.0% by 2016, though significant disparities persist among ethnoracial minority beneficiaries. 4