A well-done AWV is genuinely valuable medicine, medication reconciliation, cognitive screening, fall risk, advance care planning. Providers who invest in doing it right deserve to capture it correctly. The Medicare Annual Wellness Visit (AWV) is a common source of both missed revenue and coding errors. The core confusion is this: the AWV is not a comprehensive physical exam. It is a structured health risk assessment and care planning visit. It is free to the patient (no deductible, no copay), but it is a billable service for the practice, and it has specific required components that must be documented.
The Two AWV Codes
| Code | Service | When to Use |
|---|---|---|
| G0438 | Initial Annual Wellness Visit | First AWV ever for this Medicare beneficiary |
| G0439 | Subsequent Annual Wellness Visit | Each year after the initial AWV |
The initial AWV (G0438) has more required components than subsequent visits and reimburses slightly higher. Once a beneficiary has had their initial AWV, all future annual visits use G0439.
What the AWV Must Include
The AWV is not a physical exam, CMS is explicit about this. The required components include:
- 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 traditional comprehensive physical exam, detailed cardiac, pulmonary, neurological examination, is not required and is technically outside the scope of the AWV. This surprises many providers and patients.
AWV vs. Initial Preventive Physical Examination
There is also a separate "Welcome to Medicare" preventive visit (IPPE, G0402) for patients within the first 12 months of their Part B enrollment. This is a one-time service, different from the AWV. It includes a comprehensive review of the patient's health and a more detailed physical examination component than the AWV. Providers who see a lot of newly Medicare-eligible patients should ensure they are capturing G0402 where appropriate, it is a different code with different requirements and a different billing window. To be specific about G0402: it is the "Welcome to Medicare" Initial Preventive Physical Examination (IPPE), a one-time visit available only within the first 12 months of Part B enrollment. It is distinct from the Annual Wellness Visit (G0438 initial, G0439 subsequent): a patient gets the IPPE once, then becomes eligible for the first AWV at least 12 months later. Do not bill G0402 and an AWV together, and do not use G0402 outside that first-year window.
Common Billing Errors
The most common AWV billing errors include: billing a traditional preventive visit code (99387/99397) instead of the AWV G-codes for Medicare patients; billing G0438 every year instead of switching to G0439 after the first AWV; and billing the AWV without documentation of the required structured components. The RVU stakes make these errors worth avoiding: G0438 (initial AWV) carries about 2.43 wRVUs and G0439 (subsequent AWV) about 1.50, so billing a subsequent AWV as if it were initial, or vice versa, misstates roughly a full wRVU. And confusing the AWV with a problem-oriented E/M (or failing to add the E/M with Modifier 25 when a real problem was addressed) leaves the 1.3 to 2.8 wRVUs of that separate visit uncaptured.
Another frequent error is the opposite: not billing the AWV at all because the visit felt like a routine physical and the front desk registered it as such. The AWV should be a distinct appointment type with its own templated documentation workflow.
A Wellness Visit, Worked Through
A 71-year-old Medicare patient comes in for what the front desk booked as a physical. During the visit you complete the health risk assessment, review and update the problem and medication lists, screen for cognitive impairment and fall risk, and build the personalized prevention plan. You did not perform a hands-on head-to-toe examination, because that is not what this visit is. Coded correctly, this is the Annual Wellness Visit (G0438 for the initial, G0439 for subsequent), not a problem-oriented E/M and not a commercial physical. Understanding that distinction is what keeps the visit both compliant and properly paid, and it is the single most common point of confusion in this code family.
Sources and Further Reading for This Chapter
- CMS, Physician Fee Schedule. https://www.cms.gov/medicare/payment/fee-schedules/physician