HCPCS code G0438 is used to report the initial Annual Wellness Visit (AWV) for Medicare beneficiaries. This visit is distinct from a routine physical exam and is designed to establish or update a personalized prevention plan, focusing on health risk assessment and preventive care rather than diagnostic or treatment services.
When to Use HCPCS Code G0438
- For the first Medicare Annual Wellness Visit a patient receives.
- When conducting a comprehensive health risk assessment, including:
- Medical and family history
- Medication review
- Functional status and safety assessment
- When creating or updating a personalized prevention plan.
- Not to be billed in the same year as the Initial Preventive Physical Examination (IPPE, also known as the “Welcome to Medicare” visit).
Billing Requirements
- Bill once per beneficiary, per lifetime, for the initial AWV.
- Must include all required elements of the AWV, such as cognitive assessment, review of risk factors, and screening schedule.
- Documentation should support the time and services provided.
- Use G0439 for subsequent annual wellness visits.
Common Clinical Scenarios
- A primary care provider sees a new Medicare patient for their first Annual Wellness Visit, reviewing medical history and setting up preventive screenings.
- A clinic establishes a prevention-focused care plan for a patient with multiple chronic conditions.
- A provider performs cognitive screening and safety assessment to guide patient-specific interventions.
Simplify AWV Documentation with OptiMantra
Billing for services like HCPCS G0438 requires careful documentation of preventive assessments and personalized care planning. OptiMantra’s EMR and practice management platform streamlines the entire process—capturing health risk assessments, managing preventive screenings, and applying the correct billing codes. With OptiMantra, providers can ensure compliance, reduce claim denials, and focus on delivering high-quality preventive care to Medicare patients.
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