- G0438 is the initial AWV, once per beneficiary lifetime, at about 2.43 wRVUs; G0439 is every year after, at about 1.50. G0402 is the separate, one-time Welcome to Medicare visit in the first 12 months of Part B.
- A head-to-toe physical is not required; the structured components (history, medications, cognitive, functional, and safety screening, prevention plan, screening schedule) support the code.
- A significant, separately identifiable problem addressed the same day is a separate E/M with Modifier 25 on the E/M line, never on the AWV code; the patient owes cost-sharing on that E/M only.
- Since January 1, 2025, G2211 can ride along with the Modifier 25 E/M when the same-day service is the AWV.
- Many practices leave the AWV uncoded because it was booked as a physical; the fix is a distinct appointment type with its own template.
Entitled, structured, and constantly misused
Every Medicare beneficiary is entitled to an Annual Wellness Visit, and it is one of the most misused codes in primary care: coded wrong by some practices and not at all by many more. The AWV is not a physical. It is free to the patient, codable for the practice, and valuable medicine when done well; the provider who does it well deserves to capture it, and the problem visit that so often rides along.
The Annual Wellness Visit
The Two AWV Codes: G0438 and G0439
| Code | Service | When to Use | Approx. wRVUs |
|---|---|---|---|
| G0438 | Initial Annual Wellness Visit | First AWV ever for this Medicare beneficiary; once per lifetime | 2.43 |
| G0439 | Subsequent Annual Wellness Visit | Each year after the initial AWV | 1.50 |
The initial AWV has more required components and reimburses higher. The quick-answer version lives at G0438 vs G0439, which Medicare wellness code.
What the AWV Must Include
The code is supported by these documented components:
- Review and update of the medical and family history
- List of current providers and suppliers
- Height, weight, BMI, blood pressure measurement
- Detection of cognitive impairment (via direct observation or a validated screening tool)
- Personalized prevention plan based on health risk factors
- Review of functional ability and safety screening
- Establishment of a screening schedule for appropriate preventive services
- Review of current medications
- Counseling on advance care planning (optional but recommended)
A comprehensive physical exam, with detailed cardiac, pulmonary, and neurological examination, is not required and is technically outside the AWV's scope. That is the single most common point of confusion in this code family.
AWV vs. the Welcome to Medicare Visit (IPPE, G0402)
The Initial Preventive Physical Examination (IPPE, G0402) is the one-time "Welcome to Medicare" visit within the first 12 months of Part B enrollment, with a more detailed examination component than the AWV. IPPE once, then the first AWV at least 12 months later; never code G0402 with an AWV or outside the first-year window. The quick-answer version is at G0402, the Welcome to Medicare visit.
| Code | Service | Window |
|---|---|---|
| G0402 | Welcome to Medicare IPPE | Once, within the first 12 months of Part B enrollment |
| G0438 | Initial AWV | Once, at least 12 months after the IPPE |
| G0439 | Subsequent AWV | Every year after the initial AWV |
Common Coding Errors
Three errors account for most AWV problems: coding a preventive visit (99387/99397) instead of the G codes; coding G0438 every year instead of switching to G0439; and coding the AWV without the required components documented. Mixing up initial and subsequent misstates roughly a full wRVU (2.43 versus 1.50), and omitting a Modifier 25 E/M when a real problem was addressed leaves 1.3 to 2.8 wRVUs uncaptured; the second half of this guide covers that. The opposite error is just as common: the AWV is never coded because the front desk booked it as a physical.
A Wellness Visit, Worked Through
A 71-year-old Medicare patient comes in for what the front desk booked as a physical. You complete the health risk assessment, update the problem and medication lists, screen for cognitive impairment and fall risk, and build the prevention plan. No head-to-toe examination, because that is not what this visit is. Coded correctly, this is the AWV (G0438 if initial, G0439 if subsequent), not a problem-oriented E/M and not a commercial physical.
AWV With an E/M on the Same Day
A patient scheduled for their AWV raises a problem that needs real evaluation. You switch from preventive to diagnostic mode mid-visit and should be paid for both halves. This is not about charging the patient more; their cost-sharing is set by their plan, not by whether you capture your own credit.
The Short Answer
Yes. Code the AWV and the problem-oriented E/M with Modifier 25 on the E/M, marking it a significant, separately identifiable service. The AWV (G0438/G0439) carries no cost-sharing; the E/M is subject to the deductible and coinsurance, so tell the patient before the visit ends.
What Is Required for Each Service
AWV portion: all of the required AWV components. E/M portion: the problem, assessment, data reviewed, decision-making, and plan, in a section that stands on its own and sits clearly apart from the AWV components.
The G2211 Opportunity
Can G2211 go on an AWV claim? Since January 1, 2025, yes: CMS carved out an exception so G2211, the longitudinal care add-on, is payable beside the Modifier 25 E/M when the same-day service that triggered the modifier is the AWV, where before 2025 any Modifier 25 on the claim blocked it. The eligibility rules for G2211 itself are taught in that guide. The full claim can include:
- G0439 (or G0438), the AWV
- 99214-25 (or the appropriate E/M level with Modifier 25), the problem-oriented E/M
- G2211, the longitudinal care add-on alongside the E/M
Supported by the facts and the note, this is one of the best-reimbursed routine primary care visit patterns for Medicare patients.
Step by Step: How to Structure the Note
- Document all required AWV components in a dedicated AWV section.
- In a separate section, document the problem completely enough to stand alone as an E/M note.
- By time, count only physician or QHP minutes attributable to the E/M work; AWV time never counts toward the E/M level. By MDM, the E/M section must support the level on its own.
- Tell the patient that a separate charge will appear for the E/M portion.
- Submit: AWV code + E/M code with Modifier 25 + G2211 (if applicable for your practice type).
When the Patient Brings a Problem to the Wellness Visit
Return to the 71-year-old above, but partway through the patient mentions a knee that has been swollen and painful for two weeks. That is a second, distinct piece of work: a focused evaluation of the knee with its own history, examination, and plan. Report the AWV and a separate office E/M with Modifier 25, wellness components in one section and the problem note in another. Coding both is correct and expected, not aggressive.
Sources and Further Reading for This Chapter
- CMS, Physician Fee Schedule. https://www.cms.gov/medicare/payment/fee-schedules/physician