What is the difference between G0438 and G0439?
Asked by: Charley Hayes | Last update: May 15, 2025Score: 4.8/5 (8 votes)
What is the difference between CPT code G0438 and G0439?
HCPCS G0439 is used to code all subsequent Medicare annual wellness visits that occur after the initial AWV (G0438). So, if used correctly, G0439 would not be used until G0402 was used to code the IPPE and G0438 was used to code the initial AWV.
Why is Medicare denying G0438?
An Annual Wellness Visit code of G0438 should not be used — and will be denied — because the patient is eligible for the Welcome to Medicare visit during the first year of enrollment. For more information on the Welcome to Medicare visit go-to CMS.
Can we bill G0439 without billing G0438?
As such, G0439 can only be used after 12 months have passed since G0438 was used for a patient. According to CMS guidelines, this means that patients are eligible on the first day of the same month the next calendar year.
What are the criteria for G0438?
Initial Annual Wellness Visits (G0438): Similar to an Initial Preventive Physical Examination, except it is available to a patient after 11 months of Medicare enrollment. This is for patients that miss their window for an Initial Preventive Physical Examination.
Annual wellness visit/G0402/G0438/G0439/when we give G0402, G0438 and G0439
What are the 3 important eligibility criteria for Medicare?
- Be age 65 or older;
- Be a U.S. resident; AND.
- Be either a U.S. citizen, OR.
- Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.
How much does Medicare pay for G0438?
INITIAL ANNUAL WELLNESS VISIT (G0438)
This visit is offered to patients only once in their lifetime. They are eligible within 11 calendar months after their IPPE. The reimbursement is around $173.
What diagnosis code should be billed with G0439?
G0439 is the HCPCS code you should use for all subsequent annual wellness visits. Its long descriptor is "Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit," while its short descriptor is "Annual wellness subseq."
What are the three types of Medicare wellness visits?
- Initial Preventive Physical Exam (IPPE)
- Initial Annual Wellness Visit (AWV)
- Subsequent AWVs.
What are the three words to remember for a Medicare wellness exam?
Word recollection (Banana, Sunrise, Chair) Have patient repeat the 3 words, tell them to remember them.
Can an RN perform an AWV?
AWVs can be completed by a provider (i.e., a physician or non-physician practitioner (NPP)), registered nurses (RNs), or other medical professionals (e.g., health educator, registered dietitian) working under direct supervision of a physician or NPP.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
Can you bill 99214 and G0439 together?
Medicare does discourage this and says there is too much 'crossover' between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.
Can you refuse a Medicare wellness visit for seniors?
People can refuse a Medicare annual wellness visit, but it is worth considering the potential benefits. Wellness visits can help healthcare professionals detect health issues early on and are an important part of preventive care.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
What does "once every 12 months" mean in Medicare?
Medicare covers a wellness visit once every 12 months (11 full months must have passed since your last visit), and you are eligible for this benefit after you have had Part B for at least 12 months.
What does G0438 include?
AWV Coding. The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans. It is important to remember that code G0438 is for the first AWV only.
Does an AWV have to be 12 months apart?
We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient's last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.
Is bloodwork part of a wellness visit?
Does a Wellness Exam Include Blood Work? Yes, a wellness exam can include blood work. However, it's important to note that the specific tests conducted during a wellness exam may vary from person to person.
How often can G0438 be billed?
Claims for HCPCS code G0438 billed more than once in a lifetime will be denied. HCPCS code G0438 (Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit) is a "one time" allowed Medicare benefit per beneficiary.
What is not covered in a Medicare annual wellness visit?
Medicare does not cover Annual Wellness Visits if they are used to discuss, plan, or alter treatment for pre-diagnosed chronic illnesses, including high cholesterol, high blood pressure, or arthritis.
Can G0439 be billed as telehealth?
Note that G-codes G9481–G9485 should be used for all telehealth services delivered in the home; the one exception is annual wellness visits, which should be billed using G0438 or G0439. No other G-codes or CPT codes should appear on the claim line for telehealth services delivered in the home.
What is the difference between a physical and an annual wellness visit?
While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.
Can you bill an AWV and E&M together?
The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.
What is the CPT code for a well visit?
At ChartSpan, we provide eligibility checks for G0438 and G0439 — the core codes for Annual Wellness Visits.