The codes G0438 and G0439 are specific Healthcare Common Procedure Coding System (HCPCS) codes used under Medicare Part B to bill for the Annual Wellness Visit (AWV). This preventive service is a yearly assessment focused on creating or updating a personalized prevention plan, not a full physical examination. The distinction between G0438 and G0439 depends on the patient’s eligibility and history: whether it is the first AWV or a subsequent one. Correctly using the codes ensures Medicare beneficiaries receive this foundational visit and all subsequent annual updates at no cost.
The Initial Preventive Health Visit
The service billed with HCPCS code G0438 is the beneficiary’s first Annual Wellness Visit. This visit establishes a comprehensive baseline for future preventive care planning. It must include a Health Risk Assessment (HRA), a self-reported questionnaire covering demographic data, health status, and behavioral risks.
The provider documents a thorough review of the patient’s medical and family history, along with a complete list of current prescription medications, providers, and durable medical equipment suppliers. Routine measurements are recorded, including height, weight, BMI, and blood pressure. A cognitive function assessment is also performed to look for signs of impairment.
The G0438 visit creates a Personalized Prevention Plan of Service (PPPS). This plan includes a written screening schedule, typically covering the next five to ten years, for appropriate preventive services based on risk factors and age. The provider offers personalized health advice and referrals to health education or preventive counseling services. This initial visit is generally reimbursed at a higher rate than subsequent visits.
The Standard Annual Wellness Check
The service billed with HCPCS code G0439 represents a Subsequent Annual Wellness Visit following the initial G0438. This visit focuses on updating the personalized prevention strategy established during the first visit. The emphasis shifts from establishing a baseline to addressing changes in health status.
The provider updates the Health Risk Assessment and reviews any changes in medical or family history that occurred in the past year. The list of current providers, medications, and suppliers is reviewed. Routine physical measurements like weight, blood pressure, and BMI are recorded to monitor changes and trends.
A cognitive impairment screening and a review of potential depression risk factors are mandatory components for ongoing mental health surveillance. The Personalized Prevention Plan of Service (PPPS) is updated, reflecting new risks, recent health events, and newly scheduled preventive screenings. This check ensures the patient’s preventive care remains relevant and proactive.
Understanding the Eligibility Timeline
The distinction between G0438 and G0439 depends entirely on the patient’s enrollment history with Medicare Part B. The G0438 code is used for the patient’s first and only Annual Wellness Visit. Eligibility begins only after the beneficiary has been enrolled in Medicare Part B for longer than 12 months.
If a patient is within the first 12 months of Part B enrollment, they are eligible for the “Welcome to Medicare” visit, billed with code G0402. Therefore, a beneficiary cannot receive the G0438 service during their first year. The G0438 visit is utilized after the first year to establish the initial prevention plan.
The G0439 code is used for all subsequent Annual Wellness Visits following the initial G0438. For a G0439 claim to be covered, 12 full months must have passed since the date of the patient’s last AWV. This determining factor is strictly time-based, requiring a provider to check the patient’s claim history. Using the wrong code, such as billing G0439 before G0438, or billing either code too soon, will result in a claim denial.