The three Medicare wellness CPT codes
In short: The Medicare wellness CPT codes are really HCPCS codes. G0438 is the first yearly wellness visit, G0439 is every one after it, and G0402 is the one-time Welcome to Medicare visit.
Your mother's notice says G0439 and nobody told you what visit that was. Or you are the one at the desk, with a claim that came back denied. Either way the question is the same: which code fits, and what makes Medicare say no?
If a wellness visit ends with a prevention plan and nobody books the follow-up, a navigator can make those calls and track them. Navigate Care explains how that works and what it may cost on its what you will pay page.
The rest of this post is the code choice. Our guide to G0402 covers the Welcome visit in full, and how to read CPT codes on a bill covers the code types. This one picks up where they stop: the yearly visit.
Why "CPT" is the wrong word, and why it doesn't matter
People search for these as CPT codes. CPT codes are five digits. These three are a letter and four digits, so they are HCPCS Level II codes, the set CMS runs. The searching habit is harmless. You will see the letter codes on Medicare claims whatever you call them.
The three wellness codes on a Medicare claim
| Code | Visit | When it applies | Cost to the patient |
|---|---|---|---|
| G0402 | Welcome to Medicare (initial preventive physical exam) | Once, in the first 12 months of Part B | Nothing if the provider accepts assignment |
| G0438 | First yearly wellness visit | After the first 12 months of coverage, once only | Nothing if the provider accepts assignment |
| G0439 | Every later yearly wellness visit | Not within 12 months of a prior wellness visit | Nothing if the provider accepts assignment |
Source: AAFP, Annual Wellness Visits and Medicare.gov, yearly wellness visits
Two details in that table matter more than the rest. G0438 can be paid once. AAFP says a second G0438 for the same person "will result in a denial." And the yearly visit isn't a physical, which comes up again below.
Which code do I use? Start with Part B and the last visit
Most wrong codes come from not knowing two dates: when Part B started and what wellness visit, if any, came before. Ask for both before you pick.
Patients often can't say. A parent may have had a wellness visit at another clinic, or in another state, and remember it as "a check-up". So don't rely on memory alone. Use the eligibility check your practice already runs, and ask the patient too. If the two disagree, the claim history is the one Medicare will read.
Work down this list and stop at the first yes.
Picking the code from the dates
| Question | If yes | If no |
|---|---|---|
| Is the patient within the first 12 months of Part B? | G0402, if no Welcome visit has been done | Go to the next question |
| Has the patient never had a yearly wellness visit? | G0438 | Go to the next question |
| Was the last wellness visit (any kind) within 12 months? | Not payable yet, so don't bill | G0439 |
Source: AAFP, Annual Wellness Visits
A few notes on that. AAFP's own wording for G0438 is that the patient is eligible "after the first 12 months of Medicare coverage," and that the patient must not have had a Welcome visit in the past 12 months. For G0439 it says "The patient cannot have had a prior AWV in the past 12 months." Medicare.gov says the same from the patient's side: the first yearly visit can't happen within 12 months of Part B enrolment or a Welcome visit, and you don't need the Welcome visit first.
Here is a round-number example, not a real patient. A man starts Part B and has a Welcome visit in the first 2 months. That is G0402, once. His first yearly visit has to wait until the first 12 months of coverage are over. When it comes, it is G0438. The visit after that is G0439, and so is every one that follows. If his office bills G0438 a second time, that is the repeat AAFP says is denied.
So the history decides everything. Three visits, three codes. Two of those codes can be paid once each. Only G0439 repeats.
Some coding pages put the cutoff differently, as "11 full months". I couldn't confirm that wording on a CMS page, so I haven't used it. Check your Medicare administrative contractor's current guidance, or the eligibility lookup you already use, before you rely on a day count.
A wellness visit is not a physical
Here is the part families and new staff both trip on. The name says "wellness", and people expect a head-to-toe exam. Medicare.gov says: "It isn't a routine physical exam." It describes the visit as conversation-based. The provider takes routine measurements, reviews history and prescriptions, and gives a written prevention checklist.
The first visit under G0438 has a defined list of elements, per AAFP:
- the patient's medical and family history
- blood pressure, height, weight and body mass index or waist circumference
- a review of depression risk factors
- a written screening schedule, such as a checklist for the next 5 to 10 years
- advance care planning, at the patient's discretion
Later visits under G0439 update the health risk assessment and the written checklist. Keep the chart to those elements. A visit that wanders into a sore knee has become something else, and the claim should say so.
That is also why the yearly physical codes don't belong on a Medicare claim. AAFP is blunt: "A yearly physical (CPT codes 99381-99397) is not covered by Medicare." If your parent expected a full physical and got a wellness visit instead, nothing went wrong. Those are two different things, and Medicare pays for one of them.
Who can perform the visit
AAFP lists a physician (MD or DO), a physician assistant and a nurse practitioner. It also lists other medical professionals, such as a health educator or a registered dietitian, working under the direct supervision of a physician. If your clinic uses clinical staff for the history and measurements, the supervision piece is the one to confirm in writing. AAFP's page doesn't define direct supervision, so use your contractor's definition.
Same day: problem visits and add-ons
This is where a free visit turns into a bill. AAFP says a separate E/M service may be billed on the same day, with modifier 25 on the E/M code. It also says the E/M "is subject to a co-payment," while the wellness visit has no deductible or coinsurance. A problem-oriented visit "is not part of this benefit."
So the claim for one appointment can carry two lines. One is free to the patient. One may not be. That is the single biggest source of "you told me it was free" calls.
For the family: ask the office, before the visit, whether anything beyond the wellness visit is likely to be billed. Medicare.gov suggests a separate appointment if there are specific health concerns, so the wellness visit stays on prevention. That is good advice for the chart too.
For the billing desk: I haven't verified rules on advance care planning or screening add-ons from a CMS page, so check those with your contractor before adding them. Don't add a service to a claim because another site says it adds revenue.
Why claims get denied, and what to check first
None of these fixes promises a claim will be paid. They are the checks to run first.
Common reasons a wellness claim is denied, and the first check
| What went wrong | First check |
|---|---|
| G0438 billed a second time | AAFP says a repeat G0438 for the same person is denied. Bill G0439 instead if the dates allow |
| G0439 billed too soon | Look up the date of the last wellness visit, any kind. It must not be within 12 months |
| Yearly physical code billed (99381-99397) | Medicare doesn't cover it per AAFP. The visit was probably a wellness visit |
| A problem visit on the same day, no modifier | Add modifier 25 to the E/M code if the visit was separate and documented |
| Services in the first 12 months of Part B | The right visit is the Welcome visit, G0402, not G0438 |
| Chart missing required elements | Compare the note to the element list above, before any appeal |
If the claim is still denied, our guides on reading a Medicare denial letter and how to appeal a Medicare denial go through the letter and the next step. We can't say an appeal will succeed.
Medicare Advantage and other payers
Under Original Medicare these G-codes are the whole story. A Medicare Advantage plan is a private plan that must cover at least what Original Medicare covers, so the wellness visit is covered there too. Our post on Medicare Part C covers how those plans work. How a particular plan wants the visit coded, and whether it accepts G-codes or its own, is something I couldn't verify from a primary source. Read the plan's provider manual or call provider services.
Commercial payers are the same story. Medicare doesn't cover the five-digit yearly physical codes, as above, so don't carry them onto a Medicare claim. What a commercial plan wants for its own members is that plan's rule, and I found no primary source to quote.
If you are the family member, not the coder
You have a notice and no coding training. Fair. The short version: the CMS wellness visits page describes the visit as one to develop or update a personalized prevention plan, covered once every 12 months. It should cost your parent nothing if the provider accepts assignment, according to Medicare.gov. Extra services added in the same appointment may not be free. Ask the office what was billed, line by line, and our Medicare Part B guide explains the deductible and coinsurance that apply to those extras. SHIP, the free State Health Insurance Assistance Program, will go through a notice with you.
Where a navigator comes in
A navigator doesn't diagnose, treat or give medical advice, and doesn't replace your parent's doctor or SHIP. The job is follow-through: calling the billing office, tracking the answer, booking the screenings the prevention plan suggests. Medicare doesn't automatically cover navigation. Eligibility depends on a qualifying condition or need and a provider visit, and we confirm your cost before you start. It is usually $0 with supplemental coverage.
Frequently asked questions
What is the CPT code for a Medicare annual wellness visit?
There isn't a five-digit CPT code for it. The first yearly visit is billed as G0438 and later ones as G0439, both HCPCS codes. The one-time Welcome to Medicare visit is G0402.
How often can G0439 be billed?
AAFP says the patient cannot have had a prior wellness visit in the past 12 months. Medicare.gov says the visit is covered once every 12 months. Some pages use "11 full months", which I could not confirm, so check your contractor's guidance.
Is there an annual wellness visit CPT code by age?
No code in G0402, G0438 or G0439 depends on age. They depend on how long the person has had Part B and which wellness visit came before.
Can I bill an E/M on the same day as the wellness visit?
AAFP says yes, if the problem visit is separate, with modifier 25 on the E/M code. The E/M is subject to a co-payment. The wellness visit is not.
Does Medicare cover a yearly physical?
No. AAFP says a yearly physical (CPT codes 99381-99397) is not covered by Medicare, and Medicare.gov says the wellness visit isn't a routine physical exam.
Does the patient pay anything for the wellness visit?
Medicare.gov says you pay nothing if your provider accepts assignment. Extra services added during the visit may carry coinsurance or the Part B deductible.
