Annual Wellness Visit coding for 2026

Which code to bill

Three codes cover Medicare preventive visits. Each one has its own timing rule.

Eligibility and timing

• A patient does not need an IPPE to qualify for an Annual Wellness Visit.
• G0438 is once per lifetime across all practices. A patient who had an initial visit elsewhere is billed G0439 at your practice.
• For the visit to visit limit, the Medicare claims system counts 11 full months starting with the month after the last wellness visit. A visit in April makes the patient eligible again the following April. Use the next eligible date from your eligibility check rather than counting by hand. Source: CMS Transmittal 2575.
• Do not bill wellness visits with the preventive medicine codes 99381 to 99397.
• When the visit is completed across more than one day, report the date the whole visit, including add-on elements, was completed.

What the initial visit must include

These are the required elements of G0438 under 42 CFR 410.15:

• Review, and administer if needed, a health risk assessment
• Establish medical and family history
• List current providers and suppliers involved in the patient's care
• Measure height, weight, body mass index (or waist circumference) and blood pressure
• Detect any cognitive impairment
• Review risk factors for depression with a standardized screening tool
• Review functional ability and safety: at minimum hearing, daily activities, fall risk and home safety
• Establish a written screening schedule for the next 5 to 10 years and a list of risk factors and conditions with interventions
• Give personalized health advice and referrals
• Review current opioid prescriptions and screen for substance use disorders
• Offer advance care planning, at the patient's discretion

What changes at a subsequent visit

G0439 updates the history, the provider list, the screening schedule and the risk list. It requires weight (or waist circumference) and blood pressure; height and body mass index are listed only for the initial visit. Cognitive assessment, the opioid review, substance use screening and personalized advice are still required. The depression and functional ability reviews are listed only for the initial visit.

New for 2026: G0136

CMS kept G0136 but changed what it means. It is now a standardized physical activity and nutrition assessment, 5 to 15 minutes, no longer the social determinants of health assessment it was in 2024 and 2025. It remains an optional wellness visit element. Use a validated tool; CMS examples include Physical Activity Vital Sign and Starting the Conversation. Source: CY2026 Physician Fee Schedule final rule.

Billing other services the same day

• Problem-oriented visit: bill 99202 to 99205 or 99211 to 99215 with modifier 25 when a significant, separately identifiable problem is addressed. The patient may owe coinsurance for that part of the visit.
• Advance care planning (99497, 99498): the patient owes nothing when it is done the same day, by the same provider, and billed with modifier 33 on the wellness visit claim. This waiver applies once a year.
• G0136: the same modifier 33 rule removes cost sharing once a year when billed with the wellness visit.
• Depression screening (G0444): not payable with G0438 or G0402, and no modifier overrides that edit. It can be billed with G0439. Source: NCCI edits, fourth quarter 2026.
• G2211: since 2025 it can be added to a modifier 25 office visit billed the same day as a wellness visit. It is never added to G0438 or G0439 themselves.
• Cognitive assessment and care plan (99483): billable in the same visit with modifier 25; coinsurance applies. Source: CMS cognitive assessment page.

Telehealth in 2026

G0438 and G0439 are on the 2026 Medicare Telehealth Services List, as are G0444, G0136, 99497 and 99498. G0402 is not. Patients can receive telehealth at home through December 31, 2027. Source: CMS telehealth list.

Common denials

These are the frequency denials CMS assigns, with their claim adjustment and remark codes.

Source: Medicare Claims Processing Manual, chapter 18, section 140.

Check eligibility before the visit

Your MAC portal, clearinghouse or the HIPAA Eligibility Transaction System returns past preventive services with dates and the next eligible date. Check it before you choose G0438 or G0439. For Medicare Advantage patients the response shows the plan, not the claims history, so ask the plan. Source: CMS MLN8816413.

2026 national payment amounts

National non-facility amounts at the 2026 conversion factor of $33.4009. Your payment differs by locality.

Calculated from the relative values in the CMS RVU26D file at national rates. Look up your locality in the CMS Physician Fee Schedule Look-Up Tool. Medicare pays the full allowed amount for the wellness visit itself because the patient has no cost sharing.

Sources

CMS Annual Wellness Visit page, 42 CFR 410.15, Claims Processing Manual chapter 18, NCCI procedure to procedure edits, 2026 telehealth list, RVU26D.