G0438
Annual Wellness Visit, Initial
Code Description
HCPCS code G0438 is used to report the Initial Annual Wellness Visit (AWV) provided to eligible Medicare beneficiaries. The visit includes a health risk assessment, review of medical and family history, medication review, measurement of routine vital signs, screening for cognitive impairment, assessment of functional ability and safety, establishment of a screening schedule, and development of a personalized prevention plan.
When to Use G0438
Common situations include:
A beneficiary is receiving their first Medicare Annual Wellness Visit.
The patient has met Medicare eligibility requirements for an Initial AWV.
A personalized prevention plan is developed or updated.
Preventive health risks are assessed.
The visit focuses on long-term preventive care rather than treatment of an acute illness.
Documentation Requirements
Documentation should include:
Health risk assessment.
Medical and family history.
Current medication list.
Height, weight, blood pressure, and other routine measurements.
Cognitive impairment assessment.
Functional ability and safety assessment.
Personalized screening schedule.
Written prevention plan provided to the patient.
Examples
Example 1
A Medicare beneficiary who completed their Welcome to Medicare Visit more than one year ago presents for their first Annual Wellness Visit. The physician reviews the patient's medical history, medications, preventive screenings, functional status, and develops a personalized prevention plan. HCPCS code G0438 is reported.
Example 2
A primary care physician performs an Initial Annual Wellness Visit that includes a health risk assessment, cognitive screening, review of risk factors, and a written preventive screening schedule. The visit qualifies for HCPCS code G0438.
Common Billing Mistakes
Common billing mistakes include:
Reporting G0438 more than once for the same Medicare beneficiary.
Billing G0438 before the patient becomes eligible.
Confusing G0438 with the Welcome to Medicare Visit.
Reporting G0438 instead of G0439 for subsequent Annual Wellness Visits.
Failing to document all required preventive components.
Related HCPCS Codes
G0439
Subsequent Annual Wellness Visit
G0402
Welcome to Medicare Preventive Visit
G2211
Visit Complexity Inherent to Evaluation and Management Services
FAQ
How is G0438 different from G0439?
G0438 is reported only for the patient's first Medicare Annual Wellness Visit. All future Annual Wellness Visits are reported with G0439.
Can G0438 be billed with an office visit?
Yes. If a medically necessary, separately identifiable Evaluation and Management (E/M) service is provided on the same date, both services may be reported when documentation supports the additional work and the appropriate modifier is appended.
Does G0438 include laboratory tests or diagnostic screenings?
No. The Annual Wellness Visit itself does not include laboratory testing or other diagnostic services. If additional medically necessary services are performed, they are generally billed separately.
Does the patient need to fast for a G0438 visit?
No. The Initial Annual Wellness Visit is a preventive planning service and typically does not require fasting because routine laboratory work is not included as part of the visit.
Code Type
HCPCS Level II
Service Type
Reported For
Preventive Visit
Initial Annual Wellness Visit
