G0438 and G0439, explained
G0438 is the first Annual Wellness Visit a patient ever has. G0439 is every one after it. Neither is a physical examination — both are a defined set of elements the visit has to contain, ending in a written screening schedule the patient takes home.
The three codes people mix up
G0402 — Welcome to Medicare visit (IPPE)
When: Once, within the first 12 months of Part B enrollment.
A separate preventive visit, not an Annual Wellness Visit. A patient who has it is not then eligible for G0438 until 12 months of Part B have passed.
G0438 — Initial Annual Wellness Visit
When: Once per lifetime, after the first 12 months of Part B enrollment.
The first AWV a patient ever has. It carries the full element set, including the first written screening schedule.
G0439 — Subsequent Annual Wellness Visit
When: Once per year after the initial one, with 11 full months since the last AWV.
Every wellness visit after the first. The element set is the same in substance; the history and the schedule are updated rather than established.
The practical trap is the interval. A subsequent AWV needs 11 full months since the last one, counted by month rather than by date, and a visit billed too early comes back. Check the patient’s last AWV date before the appointment, not after.
What the visit has to contain
The required elements, in visit order. This is the same list the builder tracks while you work.
- Health risk assessment completed
- Medical and family history
- Current providers, suppliers and medications
- Routine measurements (height, weight, BMI, BP)
- Detection of cognitive impairment
- Depression / mood screen
- Functional ability and safety (ADLs, falls, home, hearing)
- Written screening schedule for the next 5 to 10 years
- Risk factors and conditions, with interventions
- Personalized health advice and referrals
The full printable checklist, with what each element means →
What it is not
It is not a head-to-toe examination. Beyond height, weight, BMI and blood pressure, the AWV does not require a physical exam, and padding one in does not make the visit stronger. It is also not the Welcome to Medicare visit, which is its own code and its own one-time window.
The element that keeps going nowhere
Detection of cognitive impairment is required at every Annual Wellness Visit. When the screen comes back positive or borderline, the Cognitive Assessment and Care Plan (CPT 99483) is the visit it calls for — a separate, longer appointment that produces a written care plan. Last year US clinicians billed 10.5 million wellness visits and 127,353 cognitive care plans. The screen happens; the next step mostly does not. What the 99483 involves →
Get the Annual Wellness Visit checklist
The whole element set, printable, with what each one means. We email it to you.
Or run the visit with the elements tracked as you go
ClinicalAssessment.io sends the health risk assessment to the patient before the appointment, shows you what is still missing before you sign, and assembles the note and the take-home prevention plan. You make every clinical decision.
Clinically reviewed by Dr Adeyinka Adegbosin (MBBS, PhD). General information, not billing or legal advice — verify current CMS requirements, frequency, and payment for your year and locality. Coverage, frequency and payment are set by CMS and your MAC; confirm current rules before you bill.