brevaG0438 vs G0439: which wellness visit code to bill
Updated October 16, 2026. G0438 is the patient's first Annual Wellness Visit and can be billed once in a lifetime. G0439 is every later wellness visit. Confirm with your Medicare Administrative Contractor before you rely on it for a claim.
The short answer
Bill G0438 when the patient has never had an Annual Wellness Visit, anywhere, and has been enrolled in Part B for more than 12 months. Bill G0439 for every wellness visit after that, as long as 11 full months have passed since the last one.
| G0438 | G0439 | |
|---|---|---|
| Long description | Annual Wellness Visit, including a personalized prevention plan of service, initial visit | Annual Wellness Visit, including a personalized prevention plan of service, subsequent visit |
| How often | Once per lifetime | Once every 12 months |
| Earliest date | More than 12 months after Part B starts, and at least 12 months after an IPPE | 11 full months after the month of the last wellness visit |
| Patient cost | None | None |
| 2026 national amount | $174.35 | $137.61 |
The lifetime rule catches practices out
G0438 counts across every practice the patient has ever seen. A new patient who had an initial wellness visit with a previous doctor is billed G0439 at yours, even though it is the first wellness visit you have done with them. Billing G0438 in that case is denied with CARC 149 and RARC N117.
Check the patient's preventive service history in your MAC portal or clearinghouse before the visit. The response lists past wellness visits and the next eligible date. Source: CMS MLN8816413.
What G0438 requires that G0439 does not
Under 42 CFR 410.15, the initial visit establishes the record the later visits update. These elements are listed for G0438 only:
- Height and body mass index (G0439 needs weight, or waist circumference, and blood pressure)
- Review of risk factors for depression with a standardized tool
- Review of functional ability and safety: hearing, daily activities, fall risk and home safety
- Establishing the medical and family history and the list of current providers and suppliers (G0439 updates them)
What both visits require
- A health risk assessment, reviewed and, if needed, administered
- Detection of any cognitive impairment
- A written screening schedule for the next 5 to 10 years, and a list of risk factors and conditions with interventions
- Personalized health advice and referrals
- Review of current opioid prescriptions and screening for substance use disorders
- Advance care planning, offered at the patient's discretion
Common mistakes
- Billing G0438 for a new patient who had an initial wellness visit elsewhere. Bill G0439.
- Billing G0439 inside 11 full months of the last wellness visit. Denied with CARC 119 and RARC N130.
- Billing either code during the first 12 months of Part B. That window belongs to the IPPE, G0402. See G0402 vs G0438.
- Reporting a preventive medicine code (99381 to 99397) for a Medicare wellness visit. Medicare does not cover those codes.
- Adding G0444 depression screening to G0438. The NCCI edit allows it only with G0439.
Read next
Eligibility and timing, including the 11-month rule. Modifiers on the wellness visit claim. 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, section 140, NCCI procedure to procedure edits.