Medicare AWV (Annual Wellness Visit) & Preventive Services Billing Guidelines

Annual Wellness Visits: G0402, G0438 & G0439

G0402 – Initial Preventive Physical Examination (IPPE):

• This code must be billed within the first 12 months of Medicare Part B enrollment.

• It can be billed only once in a lifetime.

• It cannot be billed after the first 12 months of Part B coverage.

• If G0402 has already been billed within the first 12 months of Medicare Part B enrollment, any subsequent wellness visit during the same 12-month period cannot be billed as another preventive wellness visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.

G0438 – Initial Annual Wellness Visit:

• This code must be billed after the first 12 months of Medicare Part B enrollment.

• It can be billed once in a lifetime.

• It cannot be billed within the first 12 months of Part B coverage.

• If G0438 has already been billed, any subsequent wellness visit within the next 12-month eligibility period cannot be billed as another Annual Wellness Visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.

• After completion of 12 months from G0438, the next eligible wellness visit should be billed using G0439.

G0439 – Subsequent Annual Wellness Visit:

• This code must be billed at least 12 months after G0438.

• It can be billed once every 12 months thereafter.

• If G0439 has already been billed, any subsequent wellness visit within the next 12-month eligibility period cannot be billed as another Annual Wellness Visit. In such cases, appropriate office visit CPT codes (99212–99215) may be billed if medically necessary.

Preventive Services CPT Codes: 99381 – 99397

Routine preventive physical exam CPT codes (99381–99397) are typically not covered by Medicare. Instead, Medicare covers:

• G0402 – Welcome to Medicare Visit (IPPE)

• G0438 – Initial Annual Wellness Visit

• G0439 – Subsequent Annual Wellness Visit

• Problem-oriented office visits (99212–99215) when medically necessary

Note: Medicare uses the “11 full months rule,” meaning the next Annual Wellness Visit (AWV) is eligible after 11 full months have passed from the previous AWV date, not exactly 365 days. For example, if the last AWV date is January 10, 2025 then the next eligible AWV date will be December 1, 2025.