Medicare Annual Wellness Visit Billing Codes
For Medicare Annual Wellness Visits, use HCPCS code G0438 for the initial "Welcome to Medicare" preventive visit or first Annual Wellness Visit, and G0439 for subsequent Annual Wellness Visits in following years.
Specific HCPCS Codes for Annual Wellness Visits
The Medicare Annual Wellness Visit is a distinct preventive benefit created in 2011 under the Affordable Care Act, separate from standard evaluation and management (E/M) codes 1.
Code Selection Based on Patient Status
G0438: Bill this code for the first Annual Wellness Visit after a patient becomes eligible for Medicare, or for patients who have never had an Annual Wellness Visit before 1
G0439: Bill this code for subsequent Annual Wellness Visits in years following the initial visit 1
Key Distinction from Standard Office Visits
Do not use standard office visit codes (99201-99205 for new patients or 99211-99215 for established patients) when billing for an Annual Wellness Visit. These are fundamentally different services with different purposes and billing requirements 2.
- Standard E/M codes (99201-99215) are for addressing active medical problems and acute/chronic disease management 2, 3
- Annual Wellness Visit codes (G0438/G0439) are specifically for preventive health screening, health risk assessment, and personalized prevention planning 1, 4
Billing Both Preventive and Problem-Focused Care
If you address both preventive care (Annual Wellness Visit) AND active medical problems during the same encounter, bill both the preventive code (G0438 or G0439) and an appropriate E/M code (99201-99215) with modifier -25 appended to the E/M code. 2
- The modifier -25 indicates that the E/M service was a significant, separately identifiable service from the preventive visit 2
- Documentation must clearly support that both services were medically necessary and distinct 2
Common Pitfalls to Avoid
Do not confuse "new patient" vs "established patient" status with Annual Wellness Visit coding. The distinction for G0438 vs G0439 is based on whether this is the patient's first or subsequent Annual Wellness Visit, not their relationship with your practice 1
Do not bill standard preventive medicine codes (99381-99397) for Medicare patients. Medicare does not reimburse these codes; use G0438/G0439 instead 2
Ensure cognitive assessment is documented, as this is a required component of the Annual Wellness Visit per CMS regulations 4