Medicare Wellness Visit Coding
No, you cannot use Z00.01 for a Medicare wellness visit—Medicare requires specific G-codes (G0438 for initial visits and G0439 for subsequent visits) instead of standard preventive care codes. 1
Correct Coding for Medicare Wellness Visits
Use Medicare-specific G-codes exclusively:
- G0438 for the initial Annual Wellness Visit (AWV) 1, 2
- G0439 for subsequent Annual Wellness Visits 1, 2
Medicare does not reimburse standard preventive care codes (99381-99397 or Z00.01) for wellness visits, making the use of these codes inappropriate and resulting in claim denials. 1
Key Distinction from Standard Preventive Visits
Medicare Annual Wellness Visits differ fundamentally from comprehensive preventive examinations:
- Focus on health risk assessment and personalized prevention planning rather than comprehensive physical examinations 1
- Include screening for cognitive impairment as a required component 1
- Do not require a comprehensive physical examination beyond blood pressure measurement 3
Billing Additional Services on the Same Day
When problem-focused care is needed during the wellness visit:
- Use modifier 25 on the wellness visit code (G0438 or G0439) when billing a separate evaluation and management service on the same day 1
- Bill an appropriate E/M code (99212-99215) in addition to the wellness visit code with modifier 25 if the visit becomes complex and requires significant problem-focused evaluation beyond the wellness visit scope 1
For developmental or cognitive screening:
- CPT 96110 can be added to the wellness visit with an appropriate modifier 1
Common Pitfall to Avoid
The most critical error is attempting to use standard preventive care codes (including Z00.01,99381-99397) for Medicare beneficiaries seeking wellness visits. This results in automatic claim denial, as Medicare has created a separate benefit structure with distinct coding requirements that must be followed. 1