{"id":170756,"date":"2026-07-31T13:51:52","date_gmt":"2026-07-31T13:51:52","guid":{"rendered":"https:\/\/pabau.com\/?p=170756"},"modified":"2026-08-17T12:04:29","modified_gmt":"2026-08-17T12:04:29","slug":"hcpcs-code-g0438","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/","title":{"rendered":"HCPCS Code G0438: Initial Annual Wellness Visit billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code G0438: Initial Annual Wellness Visit billing guide\",\"description\":\"HCPCS Code G0438 covers the initial Medicare Annual Wellness Visit. Learn eligibility, required components, documentation, reimbursement rates, and G0438 vs G0439.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0438\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-30\",\"dateModified\":\"2026-08-03\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS Code G0438 covers a patient&#8217;s first Annual Wellness Visit (AWV) under Medicare. The patient must have held Part B coverage for more than 12 months.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>G0438 is billed only once per patient lifetime. Every AWV after that one uses G0439 instead.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The visit is free to patients when the provider accepts Medicare assignment. Adding a same-day E&#038;M requires Modifier 25 and separate documentation.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau can automate G0438 eligibility checks, documentation templates, and claim submission to reduce denials.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">HCPCS Code G0438: what the initial annual wellness visit covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>HCPCS Code G0438<\/strong> bills Medicare Part B for a patient&#8217;s <em>first<\/em> Annual Wellness Visit (AWV). The Centers for Medicare and Medicaid Services (<a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a>) lists it in HCPCS Level II, so it is a G-code and not a CPT code. It was created under Section 4103 of the Affordable Care Act (ACA) and took effect on January 1, 2011.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The official CMS descriptor reads: <em>Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit.<\/em> That phrase carries four clinical obligations. You need a health risk assessment (HRA), a full medical and family history review, a prevention plan, and a set of preventive screenings.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Below you will find the eligibility rules, the G0439 distinction, 2026 reimbursement rates, the same-day E&amp;M rules, and the documentation an audit asks for.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">G0438 vs G0439: initial vs subsequent annual wellness visit<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Choosing between G0438 and <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0439\/\" rel=\"noopener\">G0439<\/a> is the first decision on any AWV claim. Billing G0438 for a patient who already had an AWV is one of the most common over-billing errors. The table below compares both codes side by side.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use case<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Frequency<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 national average<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0438<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial AWV with PPPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient&#8217;s first-ever AWV under Medicare<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per lifetime (per patient)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$170-$180<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0439<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent AWV with PPPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Every AWV after the patient&#8217;s first<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per calendar year (after initial)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$115-$130<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">G0439 is not limited to the same provider. If your patient had their initial AWV at another practice, you still bill G0439. Medicare tracks AWV history at the beneficiary level, not at the practice level. <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\" rel=\"noopener\">Claims management software<\/a> that flags prior AWV history at the eligibility check catches this before the claim goes out.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0438\/fully-integrated-with-pabau-billing.webp\" alt=\"Fully integrated with Pabau billing\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s built-in billing ties each AWV claim to the visit record, so G0438 goes out with its documentation attached.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<h2 class=\"wp-block-heading\">Patient eligibility for G0438<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Four conditions must all be true before G0438 can be billed. Missing any one of them results in denial.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Medicare Part B enrollment for more than 12 months.<\/strong> The patient must have been enrolled in Medicare Part B continuously for at least 12 months at the time of the visit. New Medicare enrollees are not yet eligible.<\/li><li><strong>No prior AWV on record.<\/strong> The patient must never have received an Annual Wellness Visit under Medicare. Any prior G0438 or G0439 claim disqualifies this code.<\/li><li><strong>No Welcome to Medicare visit (G0402\/IPPE) within the prior 12 months.<\/strong> If the patient received the Initial Preventive Physical Examination (IPPE) in the preceding 12 months, G0438 cannot be billed until that window clears.<\/li><li><strong>Provider accepts Medicare assignment.<\/strong> When assignment is accepted, the AWV is provided at no cost to the patient (no copay, no coinsurance). If a same-day medically necessary E&#038;M is also billed, the patient may owe cost-sharing for that separate service.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices using wellness clinic software with Medicare eligibility verification can surface all four conditions at scheduling. Checking then, rather than at billing, removes the most common G0438 eligibility denials.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">G0438 vs G0402: annual wellness visit vs Welcome to Medicare<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Many practices and patients confuse the AWV with the IPPE (G0402). They serve different purposes and cover different populations. Sequencing matters too. A patient who received an IPPE cannot have a G0438 within the following 12 months. Once that window expires, G0438 is billable.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Feature<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">G0402 (IPPE \/ Welcome to Medicare)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">G0438 (Initial AWV)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Purpose<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Orientation to Medicare benefits; baseline physical exam<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Preventive planning; personalized prevention plan creation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Eligibility window<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First 12 months of Medicare Part B enrollment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">After 12 months of Part B enrollment; no prior AWV<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physical exam included<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No (preventive focus only)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">PPPS required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (mandatory)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Frequency<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per Medicare lifetime<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per Medicare lifetime (then G0439 annually)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 class=\"wp-block-heading\">Required components of the annual wellness visit<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS requires specific clinical elements to be completed and documented before G0438 can be billed. A visit that omits any mandatory component is not a billable AWV, regardless of the time spent with the patient. Practices using standardized medical forms for each visit element reduce the risk of an incomplete record.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Health Risk Assessment (HRA).<\/strong> A structured questionnaire completed by the patient (or with assistance) covering self-reported health status, functional ability, fall risk, psychosocial needs, and behavioral health history.<\/li><li><strong>Medical and family history review.<\/strong> Current conditions, surgeries, hospitalizations, and a first- and second-degree family medical history. A hereditary risk found here may warrant a referral for genetic counseling, billed under S0265.<\/li><li><strong>List of current providers and suppliers.<\/strong> Documentation of all clinicians currently involved in the patient&#8217;s care and all current medications, including supplements.<\/li><li><strong>Baseline measurements.<\/strong> Height, weight, BMI, blood pressure, and other routine vitals relevant to the patient&#8217;s risk profile.<\/li><li><strong>Cognitive assessment.<\/strong> Screening for cognitive impairment; the provider must document the assessment method used.<\/li><li><strong>Depression screening.<\/strong> A validated screening tool such as the PHQ-2 or PHQ-9 must be applied and the results documented.<\/li><li><strong>Personalized Prevention Plan of Service (PPPS).<\/strong> A written plan individualized to the patient. It covers a 5-to-10-year schedule of preventive services, an advance care planning discussion where applicable, and any referrals. Where a relative provides day-to-day support, a caregiver care plan documents that side of it.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Documentation requirements for G0438<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation failures account for a significant share of G0438 claim denials. The RAC audit program&#8217;s CMS-approved topic 0028 specifically targets AWV excessive units and inadequate documentation. Your medical record must contain each of the following to withstand an audit.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Completed HRA form<\/strong> with patient responses or provider-assisted entries<\/li><li><strong>PPPS document<\/strong>, individualized and dated for this visit<\/li><li><strong>Cognitive impairment screening results<\/strong> with the tool name recorded<\/li><li><strong>Depression screening results<\/strong> with the validated tool name and score<\/li><li><strong>Blood pressure, BMI, and vitals<\/strong> recorded at this visit<\/li><li><strong>List of current medications and providers<\/strong> reviewed and updated<\/li><li><strong>Provider attestation<\/strong> confirming all required AWV elements were completed<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that use digital intake forms tied to structured clinical templates can auto-populate most of these fields. Patient-completed questionnaires cut the documentation load on clinicians and reduce the risk of missing a required element. <\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0438\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s customizable intake forms feed HRA and screening answers into the patient record, so the AWV note is complete before billing.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a pre-visit eligibility check for every scheduled AWV. Confirm Part B enrollment date, check for any prior G0438 or G0439 claim, and verify no IPPE was billed in the prior 12 months. Catching eligibility issues before the visit prevents rework and protects revenue.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">How to bill G0438: step by step<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Billing G0438 follows a defined sequence. Skipping or misordering any step introduces denial risk. Practices that run scheduling and billing from the same primary care software can automate most of these steps.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Confirm eligibility before the visit.<\/strong> Verify Medicare Part B enrollment duration, confirm no prior AWV on file, and check for a recent IPPE. Use your clearinghouse or payer portal for real-time eligibility verification.<\/li><li><strong>Complete all required AWV elements during the visit.<\/strong> That means the HRA, the cognitive assessment, the depression screening, vitals, the medication review, and the PPPS. Do not bill G0438 if any mandatory element was skipped.<\/li><li><strong>Select G0438 as the primary HCPCS code.<\/strong> Do not add a CPT E&#038;M code (such as 99213 or 99214) unless a medically necessary, separately identifiable service was also provided.<\/li><li><strong>Attach companion ICD-10 diagnosis codes.<\/strong> Use Z00.00 (general adult medical exam without abnormal findings) or Z00.01 (with abnormal findings) as the primary diagnosis. Additional Z codes for specific screenings performed may be added.<\/li><li><strong>Append Modifier 25 only when a same-day E&#038;M is billed.<\/strong> If you bill a medically necessary E&#038;M on the same date, append Modifier 25 to the E&#038;M code. Separate, distinctly documented clinical findings must support it. The AWV itself does not use Modifier 25.<\/li><li><strong>Submit to Medicare Part B.<\/strong> Bill to the patient&#8217;s Medicare Part B carrier. Place of service code 11 is typical for an office visit. Telehealth visits may use POS 02 with the applicable telehealth modifier.<\/li><li><strong>Document any same-day E&#038;M in its own note.<\/strong> If billing both G0438 and an E&#038;M, that note must stand entirely on its own clinical content, with no reliance on the AWV documentation.<\/li><\/ol>\n\n\n\n<h2 class=\"wp-block-heading\">G0438 reimbursement rate and fee schedule 2026<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for G0438 varies by geographic locality. The national average for 2026 falls in the range of $170 to $180 for the initial AWV. Always verify your local rate with the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> lookup tool. Rates are adjusted by geographic practice cost indices (GPCI) and updated each year in the fee schedule final rule.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Service<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 national average (approx.)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Patient cost share<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0438<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial AWV with PPPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$170-$180<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$0 (provider accepts assignment)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0439<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent AWV with PPPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$115-$130<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$0 (provider accepts assignment)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0402<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IPPE \/ Welcome to Medicare<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$175-$185<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$0 (provider accepts assignment)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Rates above reflect national averages and are subject to locality adjustments. Practices in high-cost urban markets typically receive higher rates. Rural practices may receive lower rates, or draw on rural health clinic supplemental payments. Confirm your own rate each January, once CMS publishes the final fee schedule.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Same-day billing: can you bill G0438 with an E&#038;M visit?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, in certain circumstances. CMS permits billing a medically necessary Evaluation and Management (E&#038;M) service on the same date as G0438. The rules are strict, and RAC auditors look closely at these pairings.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The E&#038;M service must be:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Medically necessary<\/strong> and clearly distinct from the AWV&#8217;s preventive scope<\/li><li><strong>Separately documented<\/strong> in the medical record with its own clinical note, distinct from AWV documentation<\/li><li><strong>Appended with Modifier 25<\/strong> on the E&#038;M code to indicate a significant, separately identifiable service was performed<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Two scenarios qualify often. The first is a patient raising an acute complaint during the visit, such as a new skin lesion that needs assessment. The second is a positive depression screen that leads into a fuller psychiatry interview and clinical decision-making.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS RAC approved topic 0028 targets AWV excessive units, including inappropriate same-day E&#038;M pairings. If your documentation does not clearly separate the two services, the E&#038;M claim will be denied. Both notes are held to the same privacy and retention standards as any other record under HIPAA.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Who can perform and bill G0438?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Physicians, nurse practitioners, physician assistants, and clinical nurse specialists enrolled with Medicare can all perform and bill the AWV. Incident-to billing situations vary. Confirm edge cases with your Medicare Administrative Contractor (MAC), especially shared visits and supervision requirements.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Physicians<\/strong> (MD, DO) in any specialty, though primary care settings are most common<\/li><li><strong>Nurse Practitioners (NPs)<\/strong> credentialed and enrolled with Medicare<\/li><li><strong>Physician Assistants (PAs)<\/strong> enrolled with Medicare and practicing within their scope<\/li><li><strong>Clinical Nurse Specialists (CNS)<\/strong> with Medicare enrollment<\/li><li><strong>Other licensed healthcare professionals<\/strong> may perform portions of the AWV under direct supervision, such as nursing staff completing the HRA. The billing provider must review and attest to all completed components<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The AWV does not require a physician. A fully credentialed NP or PA can complete the visit and bill G0438 under their own NPI. All required elements still have to be completed and documented. <\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0438\/manage-schedule-across-gps-locations-and-rooms.webp\" alt=\"Manage schedule across providers, locations and rooms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s scheduling view shows which provider is booked for each AWV, so delegation and supervision stay documented.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Build a G0438 visit checklist into your EHR or practice management platform. Assign each required element as a structured task, from the HRA through to the PPPS. Every task has to be marked complete before the AWV claim can go out. That is what stops incomplete-documentation denials at scale.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Common G0438 billing errors and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The following mistakes appear repeatedly in Medicare AWV audits and claim denials. Most are preventable with the right billing system configuration and a short staff briefing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Error<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Consequence<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Prevention<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing G0438 more than once per patient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Automatic denial; potential RAC audit flag<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Eligibility check at scheduling confirms prior G0438 history<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Using G0438 for a subsequent AWV (should be G0439)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Denial; possible over-billing allegation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">AWV history lookup before visit coding<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing HRA or PPPS in the medical record<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-payment audit; recoupment demand<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Structured visit templates with completion checkboxes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Omitting Modifier 25 on a same-day E&#038;M<\/td>\n<td style=\"padding:12px 16px;color:#374151\">E&#038;M claim denied; no appeal pathway without the modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing system rules that auto-prompt Modifier 25 when G0438 + E&#038;M are co-submitted<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Incorrect ICD-10 diagnosis code attached<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Claim denial for mismatched medical necessity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Default Z00.00 or Z00.01 mapped to G0438 in billing system<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing within 12 months of a G0402 IPPE<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Denial based on eligibility window violation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IPPE date check integrated into pre-visit eligibility workflow<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 class=\"wp-block-heading\">Companion ICD-10 codes for G0438<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every G0438 claim requires at least one supporting ICD-10-CM diagnosis code. CMS requires the diagnosis code to reflect the reason for the visit. For a standard AWV with no acute findings, Z00.00 is the correct primary code. When the visit uncovers abnormal findings that are documented and addressed, Z00.01 applies instead.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10 code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z00.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for general adult medical exam without abnormal findings<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard AWV, no abnormal findings identified<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z00.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for general adult medical exam with abnormal findings<\/td>\n<td style=\"padding:12px 16px;color:#374151\">AWV identifies abnormal findings that are documented and require attention<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z13.88<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for screening for disorder due to exposure to contaminants<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on when specific environmental screening is conducted<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z13.89<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for screening for other disorders<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on for additional screenings documented at the visit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Only attach additional Z codes for screenings that were performed and documented at this visit. Do not default-add screening codes without matching documentation. The <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS code database<\/a> lists the code ranges, and the <a href=\"https:\/\/www.cms.gov\/medicare\/coverage\/preventive-services\/medicare-wellness-visits\/annual-wellness-visit\" target=\"_blank\" rel=\"nofollow noopener\">CMS annual wellness visit<\/a> page covers how CMS treats AWV diagnosis coding.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How practice management software supports G0438 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most AWV denials come from workflow breakdowns rather than coding knowledge. Coders know the rules. Three things tend to go wrong instead.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The eligibility check never happened at scheduling.<\/li><li>Nothing prompted the HRA during the visit itself.<\/li><li>The PPPS ended up in a free-text note that an auditor cannot follow.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau closes all three. With automated billing workflows, you set rules that fire at the right point in the visit.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Trigger an AWV eligibility check as soon as an AWV appointment type is booked.<\/li><li>Block G0438 when a prior AWV claim already sits on the patient&#8217;s record.<\/li><li>Prompt for Modifier 25 when an E&amp;M code is submitted alongside G0438.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0438\/appointment-scheduling-in-pabau.webp\" alt=\"Appointment scheduling in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Booking an AWV appointment type in Pabau can trigger the eligibility check before the patient arrives.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<p class=\"wp-block-paragraph\">Pabau also supports structured AWV documentation templates, clearinghouse submission, and real-time eligibility verification. For practices running high volumes of preventive visits, that cuts administrative time per visit. It also helps them keep AWV revenue that leaks out through avoidable billing errors.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related HCPCS codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0155\/\">HCPCS code G0155 \u2014 Clinical Social Worker Home Health Billing<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0442\/\">HCPCS code G0442 \u2014 Medicare alcohol misuse screening<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0447\/\">HCPCS Code G0447 \u2014 Behavioral counseling for obesity<\/a><\/li>\n<\/ul>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Automate your Medicare AWV billing workflow                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps primary care and wellness practices verify G0438 eligibility, complete structured AWV documentation, and submit claims to Medicare Part B, all from one platform.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management platform\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0438 can only be billed once for each patient, so a wrong code choice is rarely fixed by a resubmission. That makes the pre-visit eligibility check the highest-value step in the whole workflow. Confirm the Part B enrollment date, the AWV history, and any IPPE in the past 12 months before the patient arrives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Everything after that follows from documentation. Capture the HRA, the screenings, and the PPPS as structured fields rather than free text. The claim and the audit trail then build themselves while the visit happens, instead of afterwards.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau builds those checks into scheduling, charting, and claim submission. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how it handles Medicare AWV workflows from booking through to payment.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a structured approach to Medicare billing compliance?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\" rel=\"noopener\">HIPAA compliance for medical offices<\/a> outlines the documentation and privacy rules that intersect with AWV billing workflows.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing a behavioral health screening on its own?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-h0002\/\" rel=\"noopener\">H0002<\/a> walks through how that screening is coded when it sits outside the wellness visit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a structured history-taking form?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/endocrine-review-of-systems\/\" rel=\"noopener\">endocrine review of systems<\/a> gives you a ready-made review sheet to attach to the visit record.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Looking for templates to support AWV documentation?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\" rel=\"noopener\">Medical forms at your healthcare practice<\/a> explains how standardized digital forms improve documentation completeness for preventive visit coding.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1785497267820\"><h3 class=\"schema-faq-question\">What is HCPCS Code G0438 used for?<\/h3> <p class=\"schema-faq-answer\">HCPCS Code G0438 is an HCPCS Level II G-code for a patient&#8217;s initial Annual Wellness Visit (AWV). The visit must include a personalized prevention plan of service (PPPS). It is distinct from a routine physical exam and focuses entirely on preventive planning, health risk assessment, and screenings required under the Affordable Care Act.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267821\"><h3 class=\"schema-faq-question\">What is the difference between G0438 and G0439?<\/h3> <p class=\"schema-faq-answer\">G0438 covers only the patient&#8217;s first-ever Medicare Annual Wellness Visit. It is a once-per-lifetime code. G0439 covers every subsequent AWV and can be billed once per calendar year after the initial visit. If your patient has ever received an AWV under Medicare at any practice, you must bill G0439, not G0438.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267822\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for G0438 in 2026?<\/h3> <p class=\"schema-faq-answer\">The national average reimbursement for G0438 in 2026 is approximately $170 to $180, subject to geographic locality adjustments. Verify your specific rate with the CMS Physician Fee Schedule lookup tool. Rates vary by region and are updated each January in the annual fee schedule final rule.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267823\"><h3 class=\"schema-faq-question\">Can G0438 be billed on the same day as an E&amp;M visit?<\/h3> <p class=\"schema-faq-answer\">Yes, if the E&amp;M service is medically necessary, distinct from the AWV&#8217;s preventive scope, and separately documented with its own clinical note. The E&amp;M code must be appended with Modifier 25 to indicate a significant, separately identifiable service. Without Modifier 25 and separate documentation, the E&amp;M claim will be denied and may trigger a RAC review under CMS topic 0028.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267824\"><h3 class=\"schema-faq-question\">Is the Annual Wellness Visit free to Medicare patients?<\/h3> <p class=\"schema-faq-answer\">Yes, when the provider accepts Medicare assignment, the AWV (G0438 or G0439) is provided at no cost to the patient with no copay or coinsurance. If a same-day E&amp;M service is also billed, the patient may owe standard cost-sharing for that separate service.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267825\"><h3 class=\"schema-faq-question\">Is G0438 a CPT code or an HCPCS code?<\/h3> <p class=\"schema-faq-answer\">G0438 is an HCPCS Level II G-code, not a CPT code. Many practices mistakenly search for an \u00abAnnual Wellness Visit CPT code,\u00bb but no CPT code covers the Medicare AWV. G0438 and G0439 are the correct HCPCS codes for billing Medicare Part B for initial and subsequent AWVs respectively.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267826\"><h3 class=\"schema-faq-question\">What is the difference between G0438 and G0402 (the IPPE)?<\/h3> <p class=\"schema-faq-answer\">G0402 is the Initial Preventive Physical Examination, also called the Welcome to Medicare visit. It covers patients in their first 12 months of Medicare Part B enrollment, and it includes a physical examination. G0438 is for patients enrolled for more than 12 months who have never had an AWV. It focuses on preventive planning and has no physical exam component. Receiving G0402 within the prior 12 months disqualifies a patient from G0438 billing until that window expires.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785497267827\"><h3 class=\"schema-faq-question\">Can a nurse practitioner or PA bill G0438?<\/h3> <p class=\"schema-faq-answer\">Yes. Nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNS) enrolled with Medicare can perform and bill G0438. They bill under their own NPI, provided every required AWV element is completed and documented. CMS does not require physician involvement for the AWV, though incident-to billing situations may have additional supervision requirements depending on the practice setting.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>G0438 bills a patient&#8217;s first Medicare Annual Wellness Visit, once per lifetime. Every AWV after that uses G0439, at about $115 to $130.<\/p>\n","protected":false},"author":81,"featured_media":170755,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548,1109],"tags":[2395,2385,3234],"class_list":["post-170756","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","category-primary-preventive-care","tag-medicare-billing","tag-medicare-coverage","tag-preventive-care-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code G0438: AWV billing rules and 2026 rates<\/title>\n<meta name=\"description\" content=\"G0438 bills a patient&#039;s first Medicare Annual Wellness Visit, once per lifetime. Every AWV after that uses G0439, at about $115 to $130.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS Code G0438: AWV billing rules and 2026 rates\" \/>\n<meta property=\"og:description\" content=\"G0438 bills a patient&#039;s first Medicare Annual Wellness Visit, once per lifetime. Every AWV after that uses G0439, at about $115 to $130.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-31T13:51:52+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T12:04:29+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/hcpcs-code-g0438.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Aleksandar Kochovski\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Aleksandar Kochovski\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minuto\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/\"},\"author\":{\"name\":\"Aleksandar Kochovski\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\"},\"headline\":\"HCPCS Code G0438: Initial Annual Wellness Visit billing guide\",\"datePublished\":\"2026-07-31T13:51:52+00:00\",\"dateModified\":\"2026-08-17T12:04:29+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/\"},\"wordCount\":2961,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-g0438.webp\",\"keywords\":[\"Medicare Billing\",\"Medicare coverage\",\"Preventive care codes\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\",\"Primary &amp; Preventive Care\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/\",\"name\":\"HCPCS Code G0438: AWV billing rules and 2026 rates\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-g0438.webp\",\"datePublished\":\"2026-07-31T13:51:52+00:00\",\"dateModified\":\"2026-08-17T12:04:29+00:00\",\"description\":\"G0438 bills a patient's first Medicare Annual Wellness Visit, once per lifetime. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/73b672a49e20bfba8161e3c17ee3dda2\",\"name\":\"Aleksandar Kochovski\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-aleksandar-kochovski-profile-picture-96x96.jpeg\",\"caption\":\"Aleksandar Kochovski\"},\"description\":\"Aleksandar is a content strategist and editor working in tech publishing, with a background in higher education. He specializes in topics around compliance in software solutions. When he's not writing at Pabau, you can find him tending to his bonsai collection or hitting the gym.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/aleksandar-kochovski\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267820\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267820\",\"name\":\"What is HCPCS Code G0438 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"HCPCS Code G0438 is an HCPCS Level II G-code for a patient's initial Annual Wellness Visit (AWV). The visit must include a personalized prevention plan of service (PPPS). It is distinct from a routine physical exam and focuses entirely on preventive planning, health risk assessment, and screenings required under the Affordable Care Act.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267821\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267821\",\"name\":\"What is the difference between G0438 and G0439?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"G0438 covers only the patient's first-ever Medicare Annual Wellness Visit. It is a once-per-lifetime code. G0439 covers every subsequent AWV and can be billed once per calendar year after the initial visit. If your patient has ever received an AWV under Medicare at any practice, you must bill G0439, not G0438.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267822\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267822\",\"name\":\"What is the Medicare reimbursement rate for G0438 in 2026?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The national average reimbursement for G0438 in 2026 is approximately $170 to $180, subject to geographic locality adjustments. Verify your specific rate with the CMS Physician Fee Schedule lookup tool. Rates vary by region and are updated each January in the annual fee schedule final rule.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267823\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267823\",\"name\":\"Can G0438 be billed on the same day as an E&amp;M visit?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes, if the E&amp;M service is medically necessary, distinct from the AWV's preventive scope, and separately documented with its own clinical note. The E&amp;M code must be appended with Modifier 25 to indicate a significant, separately identifiable service. Without Modifier 25 and separate documentation, the E&amp;M claim will be denied and may trigger a RAC review under CMS topic 0028.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267824\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/hcpcs-code-g0438\\\/#faq-question-1785497267824\",\"name\":\"Is the Annual Wellness Visit free to Medicare patients?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes, when the provider accepts Medicare assignment, the AWV (G0438 or G0439) is provided at no cost to the patient with no copay or coinsurance. 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He specializes in topics around compliance in software solutions. When he's not writing at Pabau, you can find him tending to his bonsai collection or hitting the gym.","url":"https:\/\/pabau.com\/es\/blog\/author\/aleksandar-kochovski\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267820","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267820","name":"What is HCPCS Code G0438 used for?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"HCPCS Code G0438 is an HCPCS Level II G-code for a patient's initial Annual Wellness Visit (AWV). The visit must include a personalized prevention plan of service (PPPS). It is distinct from a routine physical exam and focuses entirely on preventive planning, health risk assessment, and screenings required under the Affordable Care Act.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267821","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267821","name":"What is the difference between G0438 and G0439?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"G0438 covers only the patient's first-ever Medicare Annual Wellness Visit. It is a once-per-lifetime code. G0439 covers every subsequent AWV and can be billed once per calendar year after the initial visit. If your patient has ever received an AWV under Medicare at any practice, you must bill G0439, not G0438.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267822","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267822","name":"What is the Medicare reimbursement rate for G0438 in 2026?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The national average reimbursement for G0438 in 2026 is approximately $170 to $180, subject to geographic locality adjustments. Verify your specific rate with the CMS Physician Fee Schedule lookup tool. Rates vary by region and are updated each January in the annual fee schedule final rule.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267823","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267823","name":"Can G0438 be billed on the same day as an E&amp;M visit?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes, if the E&amp;M service is medically necessary, distinct from the AWV's preventive scope, and separately documented with its own clinical note. The E&amp;M code must be appended with Modifier 25 to indicate a significant, separately identifiable service. 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G0438 and G0439 are the correct HCPCS codes for billing Medicare Part B for initial and subsequent AWVs respectively.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267826","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267826","name":"What is the difference between G0438 and G0402 (the IPPE)?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"G0402 is the Initial Preventive Physical Examination, also called the Welcome to Medicare visit. It covers patients in their first 12 months of Medicare Part B enrollment, and it includes a physical examination. G0438 is for patients enrolled for more than 12 months who have never had an AWV. It focuses on preventive planning and has no physical exam component. Receiving G0402 within the prior 12 months disqualifies a patient from G0438 billing until that window expires.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267827","position":8,"url":"https:\/\/pabau.com\/es\/procedure-codes\/hcpcs-code-g0438\/#faq-question-1785497267827","name":"Can a nurse practitioner or PA bill G0438?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. Nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNS) enrolled with Medicare can perform and bill G0438. They bill under their own NPI, provided every required AWV element is completed and documented. 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