G0438 & G0439: Medicare Annual Wellness Visit
The Annual Wellness Visit (AWV) is one of Medicare's most common preventive services. Understanding what it includes - and what documentation should be in your record - helps you verify the service and prepare for any questions about your care.
What is included in a Medicare Annual Wellness Visit (G0438/G0439)?
The Medicare Annual Wellness Visit includes a Health Risk Assessment (HRA), review of medical and family history, list of current medications, measurement of vital signs, cognitive assessment, personalized health advice, and a written screening schedule. G0438 covers the initial AWV and G0439 covers subsequent annual visits. These are preventive services with no copay for Medicare beneficiaries.
Code Overview
G0438
Initial Annual Wellness Visit
- • Your first AWV with Medicare
- • More thorough history-taking
- • Establishes baseline information
- • One-time code (then G0439 thereafter)
G0439
Subsequent Annual Wellness Visit
- • All AWVs after your first
- • Updates your prevention plan
- • Reviews changes since last visit
- • Available once per 12-month period
Official CMS Description
The Annual Wellness Visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan is designed to help prevent disease and disability based on your current health and risk factors.
Important: AWV ≠ Physical Exam
The Annual Wellness Visit is NOT the same as a full physical examination. This is a common source of confusion.
Annual Wellness Visit IS:
- • A preventive planning visit
- • Risk assessment and screening schedule
- • Review of health history
- • Personalized prevention plan
Annual Wellness Visit is NOT:
- • Full physical exam
- • Head-to-toe examination
- • Treatment for current conditions
- • Diagnostic testing (unless separately billed)
What's Included in Your AWV
CMS requires specific elements for both the Initial and Subsequent AWV. This is what should be documented in your medical record.
1. Health Risk Assessment (HRA)
A structured questionnaire that collects information about your health status and risk factors. CMS requires the following domains:
Demographic Data
- • Age, gender, race/ethnicity
- • Living situation
- • Education level
Health Status Self-Assessment
- • How you rate your own health
- • Functional status
- • Quality of life indicators
Psychosocial Risks
- • Depression screening
- • Life satisfaction
- • Stress, anger, loneliness
- • Social isolation
- • Pain and fatigue
Behavioral Risks
- • Tobacco use
- • Physical activity
- • Nutrition and oral health
- • Alcohol consumption
- • Sexual health
- • Motor vehicle safety
- • Home safety
Activities of Daily Living (ADLs)
- • Dressing, feeding, toileting
- • Grooming
- • Physical ambulation / fall risk
- • Bathing
Instrumental ADLs (IADLs)
- • Using the phone
- • Food preparation
- • Housekeeping, laundry
- • Transportation, shopping
- • Managing medications
- • Handling finances
2. Medical and Family History
Documentation of your health background and hereditary conditions:
- ✔Past medical and surgical history (illnesses, hospital stays, operations)
- ✔Allergies, injuries, and treatments
- ✔Family medical history (parents, siblings, children)
- ✔Hereditary conditions that may affect your risk
- ✔Current medications, supplements, and other substances
3. Current Provider List
A list of all healthcare providers and suppliers who regularly provide care to you. This helps coordinate your care and ensure your prevention plan accounts for all your healthcare relationships.
4. Screening Schedule (5-10 Years)
A written schedule of recommended screenings based on your age, risk factors, and health status. This follows CMS and USPSTF recommendations for preventive services.
5. Risk Factors and Conditions Identified
Documentation of modifiable risk factors and conditions for which interventions are recommended. This drives your personalized prevention plan.
6. Personalized Prevention Plan
A written plan that addresses your identified risk factors with specific recommendations for prevention and health improvement. This is the core deliverable of the AWV.
Frequency and Eligibility
Eligibility Requirements
- ✔You must have Medicare Part B
- ✔For G0438: No previous AWV billed to Medicare
- ✔For G0439: At least 12 months since last AWV (G0438 or G0439)
Cost to You
Medicare covers the AWV at 100% - there is no deductible or coinsurance for the wellness visit itself. However, if your provider performs additional tests or services during the visit, those may be billed separately and subject to cost-sharing.
Payment & Denial Intelligence
Common Denial Reasons
Frequency Limit
AWV billed within 12 months of previous AWV. This is the most common denial.
Incomplete HRA
Health Risk Assessment missing required domains (psychosocial, behavioral, ADLs).
Missing Prevention Plan
No documented personalized prevention plan - the core deliverable of the AWV.
AWV vs. Physical Confusion
Documentation reflects a physical exam rather than the preventive planning elements.
Compliance Risk Level
MEDIUMAWV codes have clearly defined requirements, making compliance more straightforward than ambiguous codes like G2211. However, the volume of AWV claims means they are frequently audited. Ensure all required elements are documented.
Patient Access Implications
Why Access Your AWV Records?
- →Verify that all AWV components were actually performed
- →Get a copy of your personalized prevention plan
- →Review your Health Risk Assessment results
- →Prepare for an appeal if your claim was denied
- →Share your screening schedule with other providers
What Records to Request
- ☐Health Risk Assessment (HRA) - the complete questionnaire
- ☐AWV encounter notes from the date of service
- ☐Personalized prevention plan
- ☐Screening schedule created during the visit
- ☐Provider list documented
Plain-Language Summary
The Annual Wellness Visit is a yearly Medicare benefit where you and your doctor create a personalized plan to keep you healthy. It's not a physical exam - instead, it focuses on understanding your health risks, planning what screenings you need, and setting health goals. Your first AWV uses code G0438; after that, G0439 is used each year. Medicare pays 100% for the AWV itself. If your claim was denied, it's usually because either it was too soon after your last AWV (must wait 12 months) or the required paperwork (like the Health Risk Assessment) wasn't complete. You can request copies of your AWV records to see exactly what was documented.
Related Resources
CMS G-Codes Overview
Complete guide to all G-codes, policy context, and documentation.
Denial Appeals Hub
AWV claim denied? Here's how to appeal.
Records Access Hub
Your HIPAA rights and how to request AWV documentation.
Provider Compliance Hub
For providers: AWV documentation standards and audit preparation.
This content is for informational purposes only and does not constitute medical or billing advice. Medicare coverage and requirements may change. Verify current requirements with CMS or your healthcare provider. Last updated: December 2025.