Annual Wellness Visit CPT Code

The annual wellness visit (AWV) is a key component of preventive health care where clinicians evaluate a patient’s overall health, address risk factors and establish or update a comprehensive care plan. For health care professionals, understanding Current Procedural Terminology (CPT) codes associated with these visits ensures accurate billing and compliance as well as effective patient care. If you find yourself asking, what is the CPT code for annual wellness visits and how does it vary by patient demographics, this blog offers detailed insights.

What is the CPT Code for Annual Wellness Visits?

CPT codes serve as a universal language between health care organizations and payers, documenting clinical services and facilitating claims processing. For annual wellness visits, the two primary codes used within Medicare are G0438 and G0439. These codes, established under the Affordable Care Act, enable organizations to bill for preventive services aimed at improving population health outcomes.

• G0438 represents the initial annual wellness visit. This visit involves a comprehensive assessment of the patient’s medical and family history, a review of risk factors for preventable diseases, and the establishment of a personalized prevention plan. It is a one-time code applicable only to the first annual wellness visit under Medicare Part B.
• G0439 is used for subsequent annual wellness visits. During these follow-up visits, clinicians revisit and refine the patient’s personalized prevention plan, updating risk assessments and tracking progress on health goals.

Medicare requires compliance with specific guidelines, including conducting cognitive assessments and health risk appraisals as part of the visit. Using the correct CPT code ensures proper reimbursement and aligns with regulatory mandates.

Annual Wellness Visit CPT Code by Age

Preventive care requirements vary across different age groups, and health care professionals must take these distinctions into account when delivering services and applying CPT codes.

Younger Adults (Ages 18-39)

For individuals under 40, annual physical examinations—not wellness visits—are typically the focus. Codes such as 99385 (new patients) and 99395 (established patients) are used to document preventive evaluations for this demographic. These exams may include screening for general health risks and counseling for lifestyle modifications.

Adults (Ages 40-64)

Between the ages of 40 and 64, preventive services expand to include screenings and assessments aligned with age-specific risks. CPT codes 99386 (new patients) and 99396 (established patients) are appropriate for this group. For patients transitioning to Medicare benefits at age 65, the initial wellness visit billed under G0438 becomes a priority, particularly as preventive care shifts focus to managing chronic conditions and addressing emerging health issues.

Seniors (Ages 65+)

For Medicare beneficiaries aged 65 and older, annual wellness visits take on a more structured emphasis. Clinicians integrate services such as cognitive impairment screening, risk factor assessment, and the development or adjustment of an individualized prevention plan. The CPT codes G0438 and G0439 are specifically for Medicare beneficiaries aged 65 and older, and preventive services for younger adults (under 65) do not fall under these codes. 

Special Considerations

Age-specific risk assessments may require additional screenings during annual wellness visits. For instance, seniors might benefit from falls risk evaluations or osteoporosis screenings, while middle-aged adults may require more frequent cardiovascular evaluations depending on their medical history. In these circumstances, health care professionals can leverage other appropriate screening CPT codes in conjunction with G0438 and G0439 as clinically indicated.

Regulatory and Compliance Considerations

Annual wellness visits must be conducted in accordance with Medicare regulations, which includes completing a Health Risk Assessment (HRA), reviewing the patient’s medical history, creating a beneficiary-centered care plan and addressing specific risk factors. Adherence to these requirements ensures that organizations achieve compliance, avoid denials and maintain audit readiness.

Health care organizations should implement robust coding workflows and training to ensure codes are applied appropriately. Proper use of G0438 and G0439 not only supports reimbursement but also reflects the delivery of high-quality preventive care.

The Importance of Accurate Coding

From a professional perspective, accurate coding is about more than billing; it is a tool for improving patient outcomes and enabling the efficient delivery of care. In fact, a study found that completion of Medicare AWVs and proper documentation of Hierarchical Condition Categories (HCC) significantly impacts quality metrics and financial outcomes for health care organizations. In the study, practices increased their AWV completion from 23.7% in 2018 to 59.8% in 2020. This jump not only reflects improved patient care but also enhanced their revenue from Medicare Advantage and Medicare Shared Savings programs.By properly utilizing CPT codes for annual wellness visits, such as G0438 and G0439, clinicians can ensure continuity of care, streamline claims processes and optimize preventive health measures tailored to individual patient needs.