Medicare Wellness Visit CPT Codes
For Medicare wellness visits, use CPT code G0438 for the Initial Preventive Physical Examination (IPPE, "Welcome to Medicare" visit) or G0439 for the first Annual Wellness Visit (AWV), and G0442 for subsequent AWVs. 1
Understanding Medicare Wellness Visit Coding
Medicare wellness visits are distinct preventive care benefits that require specific G codes rather than standard evaluation and management (E/M) codes:
- G0438: Initial Preventive Physical Examination (IPPE) - the "Welcome to Medicare" visit, performed within the first 12 months of Medicare Part B enrollment 1
- G0439: Annual Wellness Visit (AWV), first visit - for beneficiaries who have not had an IPPE or AWV within the past 12 months 1
- G0442: Annual Wellness Visit (AWV), subsequent visit - for beneficiaries who have had either an IPPE or a previous AWV 1
Key Distinctions from Standard Office Visits
Medicare wellness visits are NOT the same as standard office visits (99201-99215) and should not be coded as such. 2 The wellness visit focuses on:
- Health risk assessment and personalized prevention plan 1
- Review of medical and family history 1
- Screening for cognitive impairment and depression 1
- Measurement of height, weight, BMI, and blood pressure 1
- Review of functional ability and safety 1
Important Billing Considerations
These wellness visits are provided without cost-sharing to Medicare beneficiaries, meaning no copayment or deductible applies. 3 However, if you address acute or chronic problems during the same visit, you may bill a separate E/M code (99211-99215) with modifier -25 to indicate a separately identifiable service, though this would be subject to the patient's deductible. 4
Common Pitfall to Avoid
Do not use standard office visit codes (99201-99215) for routine Medicare wellness visits, as these will be rejected when the dedicated wellness G codes exist. 2 The CMS specifically created these G codes for Medicare wellness visits, and while they may not have widespread recognition among all payers, they are the required codes for Medicare. 4
Documentation must support the wellness visit requirements, including completion of the health risk assessment and development of a personalized prevention plan. 1 Inadequate documentation is a common reason for claim denials. 2