Annual Wellness Visit Billing Guide (G0438 & G0439)
Revenue Opportunity: $118–$175/visit
Per eligible patient based on national Medicare rates
The Annual Wellness Visit (AWV) is one of the most underutilized preventive services in Medicare. Unlike a traditional annual physical, the AWV is a structured health risk assessment and personalized prevention plan that CMS reimburses at $118-175 per visit — with zero patient copay.
Despite having no cost-sharing for patients and strong reimbursement for providers, national AWV completion rates hover around 50%. For many practices, this means hundreds of eligible patients who could be seen for an AWV each year — generating significant revenue while improving population health outcomes.
G0438 vs. G0439: Initial and Subsequent AWV
Medicare uses two HCPCS codes for AWV billing, depending on whether the patient has had an AWV before.
- G0438 — Initial Preventive Physical Examination (IPPE) / Welcome to Medicare visit, OR first-ever AWV. Reimbursement: ~$175. Can only be billed once per patient's Medicare lifetime.
- G0439 — Subsequent AWV (annual). Reimbursement: ~$119. Billable once per 12-month period after the initial AWV.
💡 Pro Tip: The AWV has ZERO patient cost-sharing — no copay, no deductible. This makes it one of the easiest services to get patients to schedule, since there's no financial barrier.
What the AWV Is (and Isn't)
The AWV is NOT a head-to-toe physical exam. It's a structured health risk assessment and personalized prevention planning session. Understanding this distinction is critical for both proper billing and efficient workflow.
The AWV includes a Health Risk Assessment (HRA) questionnaire, review of medical and family history, establishing or updating a list of current providers and medications, height, weight, BMI, blood pressure, cognitive assessment, screening schedule development, and a personalized written prevention plan.
Common PitfallDo NOT perform a comprehensive physical exam and bill it as an AWV. If you need to do a problem-oriented exam, bill the appropriate E&M code with modifier 25 in addition to the AWV. Combining G0439 + 99214 (with modifier 25) is legitimate when documented properly.
Health Risk Assessment (HRA) Requirements
The HRA is the cornerstone of every AWV. CMS requires a structured questionnaire that collects information about the patient's health status, psychosocial risks, and behavioral risks. The HRA must be completed by the patient (or with staff assistance) and reviewed by the provider.
- Demographic data (age, gender, race/ethnicity)
- Self-assessment of health status and function (ADLs/IADLs)
- Psychosocial risks (depression screening, social isolation, safety concerns)
- Behavioral risks (smoking, alcohol use, physical activity, nutrition, seatbelt use)
- List of current medications (including OTC and supplements)
- Review of cognitive function (observation-based or validated tool like the Mini-Cog)
Personalized Prevention Plan
After completing the HRA, providers must create a written, individualized prevention plan that includes a screening schedule for the next 5-10 years based on USPSTF recommendations, updated list of risk factors and conditions, a list of treatment recommendations, and referrals to preventive services.
This plan must be provided to the patient in writing. Many practices use templated EHR forms that auto-populate based on HRA responses, making this process efficient and consistent.
Maximizing AWV Revenue with Add-On Billing
The AWV visit is an excellent opportunity to layer additional reimbursable services. When properly documented and medically necessary, several services can be billed alongside the AWV.
- E&M code (99212-99215) with modifier 25 — when a separate, identifiable problem is addressed during the same visit
- Advance Care Planning (99497) — discussing living wills, healthcare proxies, and end-of-life preferences. Adds ~$86
- Depression screening (G0444) — if not included in the HRA. Adds ~$19
- Alcohol screening and counseling (G0442/G0443) — if clinically indicated
- Tobacco cessation counseling (99406/99407) — for current smokers
💡 Pro Tip: AWV + Advance Care Planning (99497) + E&M with modifier 25 can turn a $119 visit into a $300+ encounter — all in a single appointment. Build these into your AWV workflow template.
Efficient AWV Workflow
Practices that successfully capture AWV revenue build a systematic workflow. Mail or electronically send the HRA questionnaire 1-2 weeks before the visit so patients arrive with it completed. Have your MA review the HRA, take vitals, and update medication lists before the provider enters.
The provider reviews the HRA, conducts the cognitive assessment, discusses the prevention plan, and addresses any new concerns. A well-designed workflow takes 20-25 minutes per patient. Schedule AWV appointments in dedicated time blocks for maximum efficiency.
Patient Identification and Outreach
The biggest barrier to AWV revenue is simply getting patients scheduled. Run a quarterly report from your EHR identifying Medicare patients who haven't had an AWV in the past 12 months. Use automated appointment reminders, patient portal messages, and proactive phone outreach.
Many practices achieve 70-80% AWV completion rates with proactive outreach. At 400 Medicare patients and 70% completion, that's 280 AWV visits at $119 each — over $33,000 in annual revenue from a single preventive service.
Key Takeaways
- 1.G0438 (initial AWV) pays ~$175; G0439 (subsequent) pays ~$119 — both with zero patient copay
- 2.The AWV is a structured health risk assessment, NOT a physical exam
- 3.Health Risk Assessment (HRA) questionnaire must be completed and reviewed
- 4.Layer additional services (ACP, depression screening, E&M w/mod 25) to reach $300+ per visit
- 5.Most practices have 50%+ of Medicare patients who haven't had an AWV in the past year
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