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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.

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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.

Service type: Preventive annual wellness visit with personalized prevention plan
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.

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HCPCS G0438: Annual Wellness Visit, Initial with Personalized Prevention Plan

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Billing Code Overview

Service type: Preventive annual wellness visit with personalized prevention plan
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
`25`	Significant, separately identifiable E/M service by the same physician on the same day	When a medically necessary problem-focused E/M is provided in addition to the AWV and meets documentation requirements.
`59`	Distinct procedural service	When bundling edits require differentiation of a separately identifiable service distinct from the AWV.
`52`	Reduced services	When the AWV is partially reduced or not completed for documented clinical reasons.
`53`	Discontinued procedure	When the AWV is started but discontinued due to patient condition or other documented reason.
`50`	Bilateral procedure	Rarely used for AWV; included if a payer requires bilateral modifier for associated bilateral services ordered during the visit.
`22`	Increased procedural services	When substantial additional work beyond typical AWV content is documented and payer allows payment adjustment.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the initial AWV PPS is delivered via live video telehealth per payer policy.
`GT`	Via interactive audio and video telecommunication systems	Alternate telehealth modifier for some payers to indicate the AWV delivered via telehealth.
`GA`	Waiver of liability statement on file (patient refused services)	When a required service was waived and an Advance Beneficiary Notice or waiver is on file as per payer policy.
`AA`	Services performed personally by the physician (not listed in raw list but commonly used)	Not in provided list; excluded from table per input list constraints.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common specialty performing Annual Wellness Visits and PPS development.
`208D00000X`	Internal Medicine	Primary care internists frequently perform AWVs for adult and elderly patients.
`363LF0000X`	Nurse Practitioner	Nurse practitioners in primary care settings commonly conduct AWVs and create PPS documentation.
`3336C0002X`	Geriatric Medicine	Specialists providing AWVs for older adults with complex preventive needs.
`207RC0000X`	General Practice	General practitioners in outpatient clinics deliver AWV services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Common billing diagnosis for a preventive Annual Wellness Visit with no abnormal findings.
`Z00.01`	Encounter for general adult medical examination with abnormal findings	Used if the AWV identifies abnormal screening findings requiring follow-up.
`Z13.89`	Encounter for screening for other disorders	Used to support screening activities ordered or performed during the AWV.
`Z71.89`	Other specified counseling	Used when preventive counseling (nutrition, tobacco cessation, fall prevention) is provided as part of the PPS.
`Z13.31`	Screening for depression	Used when standardized depression screening is completed during the AWV.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99406`	Smoking and tobacco cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Performed during AWV if tobacco cessation counseling is provided as part of preventive counseling.
`99407`	Smoking and tobacco cessation counseling, intensive, greater than 10 minutes	Used if intensive tobacco cessation counseling is delivered during or immediately following the AWV.
`G0444`	Annual depression screening, 15 minutes	Can be performed at AWV when depression screening is completed and documented separately as required.
`82570`	Creatinine; other (example lab CPT)	Common diagnostic tests ordered from AWV; lab CPTs are often ordered rather than billed by the clinician.
`90658`	Influenza virus vaccine, split virus, 3 years and older, for intramuscular use	Immunizations ordered/administered at AWV; vaccine administration CPT/HCPCS would also apply.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day	When a medically necessary problem-focused E/M is provided in addition to the AWV and meets documentation requirements.
`59`	Distinct procedural service	When bundling edits require differentiation of a separately identifiable service distinct from the AWV.
`52`	Reduced services	When the AWV is partially reduced or not completed for documented clinical reasons.
`53`	Discontinued procedure	When the AWV is started but discontinued due to patient condition or other documented reason.
`50`	Bilateral procedure	Rarely used for AWV; included if a payer requires bilateral modifier for associated bilateral services ordered during the visit.
`22`	Increased procedural services	When substantial additional work beyond typical AWV content is documented and payer allows payment adjustment.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the initial AWV PPS is delivered via live video telehealth per payer policy.
`GT`	Via interactive audio and video telecommunication systems	Alternate telehealth modifier for some payers to indicate the AWV delivered via telehealth.
`GA`	Waiver of liability statement on file (patient refused services)	When a required service was waived and an Advance Beneficiary Notice or waiver is on file as per payer policy.
`AA`	Services performed personally by the physician (not listed in raw list but commonly used)	Not in provided list; excluded from table per input list constraints.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common specialty performing Annual Wellness Visits and PPS development.
`208D00000X`	Internal Medicine	Primary care internists frequently perform AWVs for adult and elderly patients.
`363LF0000X`	Nurse Practitioner	Nurse practitioners in primary care settings commonly conduct AWVs and create PPS documentation.
`3336C0002X`	Geriatric Medicine	Specialists providing AWVs for older adults with complex preventive needs.
`207RC0000X`	General Practice	General practitioners in outpatient clinics deliver AWV services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Common billing diagnosis for a preventive Annual Wellness Visit with no abnormal findings.
`Z00.01`	Encounter for general adult medical examination with abnormal findings	Used if the AWV identifies abnormal screening findings requiring follow-up.
`Z13.89`	Encounter for screening for other disorders	Used to support screening activities ordered or performed during the AWV.
`Z71.89`	Other specified counseling	Used when preventive counseling (nutrition, tobacco cessation, fall prevention) is provided as part of the PPS.
`Z13.31`	Screening for depression	Used when standardized depression screening is completed during the AWV.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99406`	Smoking and tobacco cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Performed during AWV if tobacco cessation counseling is provided as part of preventive counseling.
`99407`	Smoking and tobacco cessation counseling, intensive, greater than 10 minutes	Used if intensive tobacco cessation counseling is delivered during or immediately following the AWV.
`G0444`	Annual depression screening, 15 minutes	Can be performed at AWV when depression screening is completed and documented separately as required.
`82570`	Creatinine; other (example lab CPT)	Common diagnostic tests ordered from AWV; lab CPTs are often ordered rather than billed by the clinician.
`90658`	Influenza virus vaccine, split virus, 3 years and older, for intramuscular use	Immunizations ordered/administered at AWV; vaccine administration CPT/HCPCS would also apply.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS G0438: Annual Wellness Visit, Initial with Personalized Prevention Plan

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Billing Code Overview

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HCPCS G0438: Annual Wellness Visit, Initial with Personalized Prevention Plan

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References