Medicare Annual Wellness Visits Do Not Use Standard E&M Codes
Medicare Annual Wellness Visits require specific G-codes (G0438 for initial visits and G0439 for subsequent visits) rather than standard Evaluation and Management codes, and using standard E&M codes will result in claim rejection. 1, 2
Correct Coding for Medicare Wellness Visits
Primary Billing Codes
- G0438: Use for the initial "Welcome to Medicare" preventive visit (first AWV) 1
- G0439: Use for subsequent annual wellness visits 1
- Standard preventive care codes (99381-99397) are NOT reimbursed by Medicare for wellness visits and will be rejected 1, 2
When E&M Codes CAN Be Used
You may bill a separate E&M code (99212-99215) in addition to the wellness visit code under specific circumstances: 1, 2
- The visit addresses acute or chronic disease management that goes beyond the wellness visit scope 1
- Modifier 25 must be appended to indicate a separately identifiable service 1, 2
- Documentation must clearly distinguish wellness components from problem-focused care 1
- Time spent on each component should be documented if billing based on time 1
- The additional E&M service will be subject to the patient's deductible (not free like the AWV) 2
Key Documentation Requirements
What Distinguishes AWVs from E&M Visits
- AWVs focus on health risk assessment, personalized prevention planning, and cognitive screening—not comprehensive physical examinations 1
- Required components include completion of health risk assessment and development of a personalized prevention plan 2
- Cognitive screening (such as the Mini-Cog) can be incorporated during Medicare AWVs 3
Billing Additional Services
- Developmental or cognitive screening (CPT 96110) can be added with appropriate modifier 1
- Therapeutic exercise codes (CPT 97110) may be used by physicians and physical therapists when teaching specific exercises 3
- Documentation must support the additional complexity and time to justify billing both the G-code and E&M code 1
Common Pitfalls to Avoid
- Do not use standard office visit codes (99201-99215) alone for Medicare wellness visits—claims will be rejected 2
- Do not assume other payers recognize G-codes—these are Medicare-specific 2
- Do not bill E&M codes without modifier 25 when performed same-day as AWV 1
- Do not inadequately document the distinction between wellness and problem-focused components, as this leads to claim denials 2