What is the ICD-10 diagnosis code for a Medicare Annual Wellness exam?

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The standard ICD-10-CM diagnosis codes for a Medicare annual wellness exam are Z00.00 (without abnormal findings) and Z00.01 (with abnormal findings).

ICD-10 Diagnosis Codes

  • Z00.00: Encounter for general adult medical examination without abnormal findings. Use this when the preventive exam reveals no new or active abnormalities.
  • Z00.01: Encounter for general adult medical examination with abnormal findings. Use this when an abnormality is newly identified or documented during the encounter.

Related Medicare Billing (HCPCS/CPT) Codes

While ICD-10 codes describe the diagnosis or reason for the encounter, Medicare requires specific HCPCS codes for billing the actual service:

  • G0402: Initial Preventive Physical Examination (IPPE), or the "Welcome to Medicare" exam (available only during the first 12 months of enrollment).
  • G0438: Initial Annual Wellness Visit (first yearly visit after the first year of enrollment).
  • G0439: Subsequent Annual Wellness Visit (for yearly follow-ups after the initial wellness visit).

What is the ICD-10 code for a routine wellness exam?

The ICD-10 code for a routine adult health examination without abnormal findings is Z00.00.

Common Routine Exam Codes

  • Z00.00: General adult medical examination without abnormal findings (routine physical).
  • Z00.01: General adult medical examination with abnormal findings.
  • Z00.129: Routine child health examination without abnormal findings (under 8 years old).
  • Z01.419: Encounter for routine gynecological examination without abnormal findings (well-woman exam).

What is the ICD-10 code for a normal wellness examination?

The standard ICD-10-CM code for a normal adult wellness or routine physical exam without abnormal findings is Z00.00.

Key ICD-10 Codes for Wellness Exams

  • Z00.00: Encounter for general adult medical examination (ages 15–124) without abnormal findings.
  • Z00.01: Encounter for general adult medical examination with abnormal findings (use an additional code for the specific new abnormality).
  • Z00.129: Encounter for routine child health examination without abnormal findings (ages 0–17).

Quick Coding Rules

  • Use Z00.00 for routine annual physicals, periodic health check-ups, and related preventive lab work when everything is normal.
  • Stable, pre-existing chronic conditions (like well-controlled high blood pressure or diabetes) do not make an exam "abnormal"—continue to report those stable conditions alongside Z00.00.
  • Use Z00.01 only if a brand-new, unexpected, or worsening medical issue is discovered during the preventive visit.

How to code a Medicare annual wellness visit?

To code a Medicare Annual Wellness Visit (AWV), use HCPCS code G0438 for an initial visit or G0439 for a subsequent yearly visit.

Core HCPCS/CPT Codes

  • G0402: Initial Preventive Physical Examination (IPPE / "Welcome to Medicare" exam)—only within the first 12 months of Part B enrollment.
  • G0438: Initial Annual Wellness Visit—first visit after being enrolled in Part B for more than 12 months (or if the IPPE window was missed).
  • G0439: Subsequent Annual Wellness Visit—yearly follow-up conducted at least 11 months after the initial AWV.
  • G0136: Administration of a standardized, evidence-based Social Determinants of Health (SDOH) risk assessment (5–15 minutes).

Diagnosis Coding (ICD-10)

  • Z00.00: Encounter for general adult medical examination without abnormal findings.
  • Z00.01: Encounter for general adult medical examination with abnormal findings.
  • Note: Report additional specific ICD-10 codes for any stable chronic or acute conditions managed or evaluated during the encounter.

Key Billing and Documentation Rules

  • Health Risk Assessment (HRA): Required for both initial and subsequent visits; must be completed by the patient or caregiver prior to or during the visit.
  • Same-Day Sick Visits: If a separate, medically necessary Evaluation and Management (E/M) service (e.g., 99213) is performed during the same encounter, append modifier -25 to the E/M code. Do not append modifiers to the wellness HCPCS code.
  • No Cost-Sharing: AWVs are covered at 100% by Medicare with zero patient deductible or coinsurance when billed with the appropriate preventive diagnosis codes.

Does Medicare cover code 99397?

Traditional (Original) Medicare does not cover CPT code 99397.

Medicare Rules for CPT 99397

  • Statutory Exclusion: Original Medicare considers routine comprehensive physical exams (represented by CPT codes 99381–99397) to be non-covered services.
  • Instead of 99397: Medicare uses specific HCPCS "G" codes for preventive care. For established patients, providers must use G0438 (Initial Annual Wellness Visit) or G0439 (Subsequent Annual Wellness Visit).
  • The Difference: A Medicare Annual Wellness Visit focuses on creating a personalized prevention plan and reviewing medical history, whereas CPT 99397 covers a traditional, hands-on physical exam.
  • Advance Beneficiary Notice (ABN): If a provider performs a routine physical exam under code 99397 for a traditional Medicare patient, they should issue an ABN Form via CMS letting the patient know Medicare will deny the claim and the patient may be billed directly.

Exceptions

  • Medicare Advantage: Some Medicare Advantage plans may cover routine physical exams using standard CPT codes like 99397, but coverage varies by specific plan. Always check with the specific plan provider beforehand.

Medicare AWV CPT Codes 2026 Update | Annual Wellness Visit Billing & Coding Guide

9 related questions found

What is the ICD-10 code for a Medicare wellness exam?

The standard ICD-10 diagnosis codes for a Medicare wellness exam are Z00.00 (general adult medical examination without abnormal findings) and Z00.01 (general adult medical examination with abnormal findings).

Medicare Billing Details

While Z-codes provide the diagnosis context, Medicare requires specific HCPCS/CPT G-codes for billing the actual wellness service rather than standard commercial preventive codes:

  • G0402: Initial Preventive Physical Examination (IPPE), or the "Welcome to Medicare" visit (one-time benefit within the first 12 months).
  • G0438: Initial Annual Wellness Visit (AWV) (once-in-a-lifetime code for the first visit after the first 12 months).
  • G0439: Subsequent Annual Wellness Visit (yearly recurring visit).

What is the difference between an AWV and a physical exam?

An Annual Wellness Visit (AWV) is a prevention-planning conversation with your doctor, while a physical exam is a hands-on, head-to-toe medical checkup of your body.

Annual Wellness Visit (AWV)

  • Main Purpose: Create or update a personalized prevention plan and review health risks.
  • What Happens: You fill out a health risk assessment questionnaire. You and your doctor talk about your medical history, current medicines, cognitive health, and safety.
  • Physical Exam: None. It is a "hands-off" appointment with no physical touch or body examination.
  • Labs and Tests: Blood work and routine lab tests are not automatically included.
  • Cost: Fully covered by Original Medicare once every 12 months with no copay.

Physical Exam

  • Main Purpose: Assess your overall current health status and look for hidden or active signs of disease.
  • What Happens: Your doctor checks your vital signs, listens to your heart and lungs, feels your abdomen, and checks your eyes, ears, and skin.
  • Physical Exam: Comprehensive and hands-on.
  • Labs and Tests: Often includes routine or diagnostic blood work, screenings, and vaccine reviews.
  • Cost: Usually requires a copay, as Original Medicare does not cover routine annual physicals.

What is the ICD-10 code for routine labs under Medicare?

The primary ICD-10 code for a routine adult medical examination is Z00.00 (Encounter for general adult medical examination without abnormal findings), but Medicare generally does not cover routine screening labs using general physical exam codes.

Medicare Coverage Rules for Lab ICD-10 Codes

  • Medical Necessity Required: Medicare only pays for diagnostic laboratory tests that meet specific Medicare coverage policies and are supported by a specific diagnosis or sign/symptom code.
  • Screening vs. Diagnostic: General wellness codes like Z00.00 are often listed on CMS Lab NCDs as non-covered for routine diagnostic blood work.
  • Specific Screening Exceptions: Medicare does cover certain specific preventive screenings (such as lipid panels, HbA1c for diabetics, or colorectal cancer screenings), which require precise preventive Z-codes (e.g., Z13.220 for lipid disorder screening) rather than a general exam code.
  • Signs and Symptoms: If a lab is ordered to evaluate a complaint (like fatigue or high blood pressure), you must code the specific symptom (R-code) or established condition (E- or I-code) rather than a routine code.

What are the ICD-10 codes for wellness?

The primary ICD-10-CM codes for routine adult wellness and general medical examinations are Z00.00 (without abnormal findings) and Z00.01 (with abnormal findings).

Core Adult Wellness Codes

  • Z00.00: Encounter for general adult medical examination without abnormal findings (used for purely preventive exams where no new or chronic worsening issues are found).
  • Z00.01: Encounter for general adult medical examination with abnormal findings (used when the routine exam reveals an abnormality, which should be listed as an additional secondary diagnosis).

Pediatric Wellness Codes (Well-Child Exams)

  • Z00.110: Health examination for newborn under 8 days old.
  • Z00.111: Health examination for newborn aged 8 to 28 days.
  • Z00.129: Encounter for routine child health examination without abnormal findings (age 29 days and older).
  • Z00.121: Encounter for routine child health examination with abnormal findings (age 29 days and older).

Medicare Annual Wellness Visit (AWV) Context

While the codes above are the standard ICD-10 diagnosis codes, Medicare and other insurers often require specific HCPCS/CPT codes to accompany them for billing:

  • G0402: Initial Preventive Physical Examination ("Welcome to Medicare" exam)
  • G0438: Initial Annual Wellness Visit
  • G0439: Subsequent Annual Wellness Visit

Can Z00 00 be a primary diagnosis for Medicare?

Yes, ICD-10 Code Z00.00 can be used as a primary or first-listed diagnosis on outpatient Medicare claims for specific preventive or wellness encounters, but it cannot be billed alone for routine physical exams or standalone lab tests.

Medicare Rules for Z00.00

  • Allowed as Primary: You can list Z00.00 (encounter for general adult medical examination without abnormal findings) as the primary or first-listed code when submitting certain general preventive visit claims where no active disease or symptom is addressed.
  • Not for Routine Physicals: Medicare statutory benefit does not cover routine annual physical exams. Submitting Z00.00 as primary for a non-covered routine physical will result in a denial.
  • Wellness Visits Instead: For Medicare Annual Wellness Visits (AWV), specific HCPCS G-codes like G0438 (initial) or G0439 (subsequent) must be used. In these cases, Z00.00 often acts as an accompanying or secondary code, or a specific prevention code depending on local contractor guidelines.
  • Laboratory Claims: Medicare generally denies diagnostic or routine laboratory claims if Z00.00 is the sole or primary diagnosis code because it is classified as a screening examination without a specific disease target.