Summary & Overview
HCPCS G0438: Annual Wellness Visit, Initial with Personalized Prevention Plan
HCPCS Level II code G0438 denotes the initial Annual Wellness Visit (AWV) that includes a Personalized Prevention Plan of Service (PPS). Nationally, AWVs are a key component of preventive care delivery and population health strategies, enabling structured risk assessment, preventive screening, and care planning. The initial AWV establishes the PPS and sets a baseline for follow-up preventive services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, typical sites of service, and which payers commonly cover the service. The publication outlines common billing considerations, lists frequently used modifiers where available, and highlights areas where policy updates can affect coverage and coding practice.
This summary prepares clinical, coding, and policy audiences to understand where G0438 fits in preventive care workflows, what to expect from major payers at a high level, and which benchmarking and policy topics to review for aligning billing and documentation practices. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code G0438 represents an annual wellness visit, initial visit that includes a personalized prevention plan of service (PPS). This service is a preventive medicine visit focused on preventive health planning rather than evaluation and management of acute or chronic illnesses.
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Service type: Preventive annual wellness visit with personalized prevention plan
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Typical site of service: Outpatient ambulatory care settings, including primary care clinics and physician offices
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 67-year-old Medicare beneficiary presents for an initial Annual Wellness Visit that includes development of a Personalized Prevention Plan of Service (PPS). The patient has no acute complaints and seeks a preventive health assessment to update preventive screening needs, immunizations, and care coordination. The visit is scheduled for a 40-minute office encounter with a primary care clinician (family medicine physician or nurse practitioner).
The clinical workflow: pre-visit staff confirm patient identity and insurance (Medicare), review prior records and preventive history, and provide a health risk assessment form for the patient to complete. During the encounter the clinician reviews medical and family history, current medications, risk factors, functional status, and cognitive assessment as appropriate. The clinician performs focused preventive counseling, documents a personalized prevention plan of service (PPS) with recommended screenings, immunizations, referrals, and health education, and provides written or electronic PPS to the patient. Orders for screening tests (for example, colorectal cancer screening, laboratory panels), immunizations, and referrals are entered, and follow-up is arranged. The visit does not include a comprehensive new patient physical exam or evaluation and management service billed separately for an acute problem. If significant unrelated evaluation/management services are performed and documented, a separate E/M code may be appropriate with modifier 25 when Medicare rules allow.
Coding Specifications
| Modifier | Description | When to Use |
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