2025 HCPCS code G0438
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Annual Wellness Visit Counseling, Screening, and Prevention Services Feed
This HCPCS code represents the initial annual wellness visit (AWV), including a personalized prevention plan of service (PPPS), for Medicare beneficiaries.
Modifiers may be applicable based on the specific circumstances of service delivery (e.g., modifier 25 for a significant, separately identifiable E/M service performed on the same day).
Medicare covers the initial AWV once per lifetime for eligible beneficiaries. The beneficiary must be enrolled in Medicare Part B for at least 12 months and not have had an IPPE or AWV within the past 12 months. The service must be medically necessary and provided by a qualified healthcare professional.
The clinical responsibility lies with the physician or qualified healthcare professional who conducts the AWV, including taking the patient's history, performing the examination, assessing risk factors, and creating a personalized prevention plan.This may involve collaboration with other healthcare professionals.
- Counseling, Screening, and Prevention Services
- G0438-G0451 (Counseling, Screening, and Prevention Services)
In simple words: This code is for your first-ever wellness checkup covered by Medicare.The doctor will talk to you about your health history, check your blood pressure and weight, and create a personalized plan to help you stay healthy for the next 10 years.
HCPCS code G0438 is used to bill Medicare for the first annual wellness visit (AWV) provided to a beneficiary.This comprehensive assessment includes a personalized prevention plan of service (PPPS). The visit involves obtaining a detailed medical, family, and social history; assessing risk factors; performing a physical examination (including height, weight, and blood pressure); and developing a personalized prevention plan for the next 10 years.This plan includes screening recommendations, a list of involved healthcare providers, and recommendations for addressing identified risk factors (e.g., smoking cessation, nutrition, physical activity).
Example 1: A 67-year-old Medicare beneficiary has not had a preventive visit since enrolling in Medicare Part B.The physician performs a comprehensive AWV, including a detailed history, risk factor assessment, and personalized prevention plan focusing on hypertension management and colorectal cancer screening., A 72-year-old patient presents for their first AWV. The physician assesses the patient's health status, identifies risk factors for diabetes and heart disease, and develops a prevention plan involving lifestyle changes and appropriate screening tests. The physician orders lab tests and schedules follow-up appointments., A 65-year-old new Medicare enrollee has a comprehensive annual wellness visit. A detailed history is taken including family history of heart disease. A personalized prevention plan is created for the patient that includes cardiac risk factor management.
Detailed medical, family, and social history;results of risk assessments; physical examination findings (including height, weight, and blood pressure);personalized prevention plan (including screening recommendations, provider list, and plans to address identified risk factors); documentation of patient education and counseling.
** Bundling rules may apply.Consult with your billing department for detailed information regarding payment and reimbursement.
- Revenue Code: 0450 (Medical examinations and other medical evaluation services)
- RVU: The RVUs for this code are determined by Medicare and vary based on geographic location and other factors.Consult the Medicare Physician Fee Schedule for current RVU values.
- Global Days: N/A
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Consult the Medicare Physician Fee Schedule for historical fee schedule data. The payment amount varies by year and geographic location.
- Specialties:Family Medicine, Internal Medicine, Geriatrics
- Place of Service:Office,Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home