Both codes describe the Medicare Annual Wellness Visit. Which one you report depends entirely on whether the patient has ever had one before.
| Code | What it is | How often | wRVU |
|---|---|---|---|
| G0402 | Welcome to Medicare | First 12 months of Part B | 2.60 |
| G0438 | Initial AWV | Once per lifetime | 2.60 |
| G0439 | Subsequent AWV | Yearly, 11 full months apart | 1.92 |
The sequence runs G0402 in the first year if it happens at all, then G0438 once, then G0439 for the rest of the patient's life. There is no second G0438. Reporting G0438 for a patient who has already had one is the most common denial in this family.
Two intervals matter. G0438 may not be reported within 12 months of G0402. And each wellness visit must fall at least 11 full months after the month of the previous one; a visit at 11 months and 2 weeks is denied, and the patient is usually the one who hears about it.
The AWV is a planning visit, not an examination. The required elements are a health risk assessment, medical and family history, a current list of providers and suppliers, medications, height, weight, blood pressure and other routine measurements, detection of cognitive impairment, a depression risk review, a functional ability and safety review, and a written personalized prevention plan with a screening schedule the patient takes home. An examination beyond vital signs is not required, and performing one does not convert the visit into a covered physical.
Medicare does not cover the preventive medicine codes 99381 through 99397. If the patient wants a comprehensive physical, that is a non covered service they pay for, distinct from the AWV. Billing a physical to Medicare because a physical was performed is the error that follows from thinking of the AWV as a checkup.
If the patient raises a problem that requires evaluation and management beyond the wellness work, that visit is separately reportable with modifier 25 on the office visit code, supported by a distinct assessment and plan for the problem. This is common and legitimate; the wellness visit and the problem visit are different services with different documentation.
The longitudinal add-on G2211 is generally not paid when an office visit carries modifier 25 for a same day minor procedure, but CMS created a narrow exception that includes the Annual Wellness Visit, so an eligible office visit reported alongside the AWV can still carry G2211. Confirm your payer follows the CMS position.
Paste a de-identified wellness visit into the Note Coding Assistant and it will identify the wellness code, test whether a separate problem visit is supported, and write the rationale. The full chapter is Medicare Annual Wellness Visits.