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Chronic Care Management
The program the wellness visit most naturally feeds.
Services
Annual Wellness Visits
What It Is
What is a Medicare annual wellness visit?
The annual wellness visit is a prevention-planning visit, not a physical examination. It centers on a health risk assessment and produces a personalized prevention plan, a screening schedule, and an updated picture of the patient's risks. G0438 covers the first one and G0439 each subsequent one, billable once in a 12-month period.
The most consequential thing to understand about the visit is what it is not. Patients arrive expecting a head-to-toe examination and are disappointed when they do not get one; staff, expecting the same, sometimes deliver an exam and document a wellness visit. Setting the expectation at scheduling is most of the work.
Requirements
What has to happen in the visit?
A health risk assessment covering, at minimum, demographic data, the patient's self-assessment of health status, psychosocial and behavioral risks, and activities of daily living including instrumental activities such as shopping, housekeeping, managing their own medications, and handling finances. Vitals are limited to height, weight, BMI or waist circumference, blood pressure, and other measurements as appropriate.
From that assessment comes the rest: a list of the patient's current providers and suppliers, a review of medical and family history, detection of cognitive impairment, a written screening schedule, personalized health advice, and referrals where indicated.
A standardized social determinants of health risk assessment may be furnished as an additional element, not more often than every six months. It is optional, and it is one of the few structured opportunities in a Medicare year to capture the non-clinical factors that drive most of the outcomes.
Sequencing
How does the AWV relate to the Welcome to Medicare visit?
The initial preventive physical examination, G0402, is the Welcome to Medicare visit and is available only within the first 12 months of Part B enrollment. The annual wellness visit comes after that. A patient cannot have both in the same 12-month window, and confusing the two is the most common reason an early claim is denied.
The practical rule for scheduling is to check the Part B enrollment date before booking. A patient in their first year of Part B is an initial preventive physical examination patient; after that, they are an annual wellness visit patient, first visit or subsequent depending on history.
Where the patient also needs a medically necessary evaluation and management service on the same day, that can generally be reported separately with the appropriate modifier, provided the work is genuinely distinct and documented as such.
Why It Matters
Why run the program at all?
Because it is the one guaranteed annual touchpoint with a Medicare patient who may otherwise only appear when something is wrong. It is where a cognitive concern is first noticed, where an unreconciled medication list surfaces, and where the following year's screenings get scheduled rather than missed.
It is also the natural entry point to the rest of a care management program. The assessment identifies who has multiple chronic conditions, who is struggling with adherence, and who has functional limitations, which is precisely the information needed to enroll the right patients in chronic care management or medication management.
Programs that treat the visit as a box to complete get the reimbursement and none of that. Programs that treat it as an intake get both.
Common Questions
Common questions
Is the annual wellness visit a physical exam?
No. It is a prevention-planning visit built around a health risk assessment. It is not a comprehensive head-to-toe examination, though a limited set of vitals is required: height, weight, BMI or waist circumference, and blood pressure.
What is the difference between G0438 and G0439?
G0438 is the first annual wellness visit; G0439 is each subsequent one. Only one may be billed in a 12-month period.
What is G0402?
The initial preventive physical examination, the Welcome to Medicare visit, available only within the first 12 months of Part B enrollment. It precedes the annual wellness visit rather than substituting for it.
Can the visit be delivered by staff?
Much of it can be performed by clinical staff under the appropriate supervision of the billing practitioner, subject to state law and scope of practice. The requirements about what must be covered do not change with who performs it.
Can we bill an office visit on the same day?
Generally yes, where a medically necessary evaluation and management service is genuinely furnished and documented as distinct from the wellness visit, reported with the appropriate modifier.
Does the patient pay anything?
The annual wellness visit is a covered preventive service furnished without coinsurance or deductible when billed as such. If a separately billable problem-oriented service is provided at the same encounter, normal cost sharing applies to that portion.
Related reading
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Comprehensive Medication Management
The medication list surfaced at the visit is where this starts.
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Annual wellness visit codes: G0438, G0439 and G0402
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Remote patient monitoring CPT codes
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Behavioral health integration CPT codes
Program requirements on this page reflect CMS guidance current as of CY2026. CMS revises preventive service requirements and code definitions annually. This page describes the service and is not billing advice for a specific claim.
Engagement and Call to Action
For seniors, engaging in Annual Wellness Visits is a proactive step toward maintaining and improving your health. These visits are a valuable resource for staying on top of your health needs and ensuring that you're taking all possible steps to live a healthy, fulfilling life. If you haven’t scheduled your Annual Wellness Visit this year, contact your healthcare provider today to make an appointment. It’s an important part of your healthcare routine and is covered by Medicare, emphasizing its value in senior healthcare management.
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