2025 HCPCS code G0439
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Annual Wellness Visit Counseling, Screening, and Prevention Services Feed
This HCPCS code represents a subsequent annual wellness visit, including a personalized prevention plan of service (PPPS), for Medicare beneficiaries.
Modifier -25 may be necessary if another significant and separately identifiable E&M service is performed on the same day.
Medical necessity for G0439 is established by the need for a follow-up annual wellness visit, subsequent to the initial visit (G0438), to address ongoing health concerns and implement a personalized prevention plan.The services must be medically necessary under Medicare guidelines.
The clinical responsibility involves the physician or qualified healthcare professional performing a comprehensive review of the patient's health status, identifying risk factors, creating a personalized prevention plan, and documenting the encounter.
In simple words: This code is for a follow-up visit to your yearly wellness check-up.The doctor will review your health history, check your vital signs, and talk to you about ways to stay healthy, such as eating better, exercising, and quitting smoking.
G0439, an HCPCS code, signifies a subsequent annual wellness visit (AWV) that incorporates a personalized prevention plan of service (PPPS).This visit follows an initial AWV (G0438) and includes updating the patient's medical and family history, reviewing current healthcare providers, performing a physical examination (including height, weight, and blood pressure), updating screening schedules, assessing and addressing identified risk factors and diseases, providing health advice (such as smoking cessation, physical activity, and nutrition guidance), and documenting the visit comprehensively in the patient's medical record, including medications, treatment history, chronic diseases, and urgent health needs.Medicare covers this service once per year, subsequent to the initial AWV.
Example 1: A 68-year-old Medicare beneficiary has their annual wellness visit. The physician updates the patient's medical history, reviews medications, assesses risk factors for heart disease and diabetes, and provides counseling on diet and exercise.G0439 is used for this subsequent visit., A 72-year-old female patient with hypertension and hyperlipidemia returns for her annual wellness visit.The provider updates her blood pressure and cholesterol levels, reviews her medications, and adjusts her treatment plan based on her risk factors. This would be billed using G0439., A 65-year-old male patient had his initial wellness visit last year.This year's visit focuses on reviewing lifestyle modifications, updating vaccinations, and screening for colorectal cancer. This visit is coded as G0439.
Comprehensive documentation is required, including the patient's medical and family history, vital signs (height, weight, blood pressure), current medications, review of systems, assessment of risk factors, personalized prevention plan, and any counseling or education provided.Documentation should clearly differentiate this visit from other services rendered on the same day.
** This code is specifically for Medicare beneficiaries.Billing requirements may vary for other payers.Always refer to the most up-to-date Medicare guidelines and payer-specific policies.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Family Medicine, Internal Medicine, Geriatrics
- Place of Service:Office, Outpatient Hospital, other settings as appropriate