brevaAnnual Wellness Visit eligibility and timing
Updated October 16, 2026. There is no age limit. Eligibility depends on how long the patient has had Part B and when the last wellness visit was. Confirm with your Medicare Administrative Contractor before you rely on it for a claim.
Is there an age limit for G0438 or G0439?
No. The Annual Wellness Visit is a Part B benefit, and Part B covers people 65 and older as well as younger people who qualify through disability or end-stage renal disease. A 52-year-old on Medicare through disability is eligible on the same timing rules as a 70-year-old.
The first 12 months of Part B
During the first 12 months of Part B coverage the patient is eligible for the Initial Preventive Physical Examination (G0402), not an Annual Wellness Visit. G0438 or G0439 billed in that window is denied with CARC 26 and RARC N130. Source: Claims Processing Manual chapter 18, section 140.
A patient does not need to have had an IPPE to qualify for a wellness visit later. Many patients skip it.
The 11-month rule between wellness visits
Medicare counts 11 full months starting with the month after the last wellness visit. A visit on April 20 makes the patient eligible again on April 1 of the following year, so the date does not drift later each year. The same gap applies between an IPPE and the first wellness visit. Source: CMS Transmittal 2575.
| Last wellness visit | Eligible again from |
|---|---|
| January 5, 2026 | January 1, 2027 |
| April 20, 2026 | April 1, 2027 |
| December 30, 2026 | December 1, 2027 |
Check before the visit, not after
Your MAC portal, clearinghouse or the HIPAA Eligibility Transaction System returns the patient's past preventive services with dates and the next eligible date. Use that date rather than counting from your own records, because the last wellness visit may have happened at another practice. For Medicare Advantage patients the response names the plan, not the claims history; ask the plan. Source: CMS MLN8816413.
Visits that run over more than one day
When the elements are completed across more than one date, report the date the whole visit was completed, including any optional elements billed with it.
Read next
G0438 vs G0439. G0402 vs G0438. Payment amounts, denial codes and the 2026 telehealth rules are on the Annual Wellness Visit coding reference.
Printable note templates: initial Annual Wellness Visit and subsequent Annual Wellness Visit. For the patient: a printable health risk assessment form.
Record the wellness visit in Breva and review the note and its suggested codes before they reach the chart. The Breva scribe.
Sources
CMS Annual Wellness Visit page, 42 CFR 410.15, Claims Processing Manual chapter 18, Transmittal 2575, MLN8816413.