Summary & Overview
HCPCS G0439: Annual Wellness Visit with Personalized Prevention Plan
HCPCS Level II code G0439 designates an annual wellness visit that includes a personalized prevention plan of service (PPS) and is used for subsequent visits. This preventive-care code is nationally significant because it supports structured, longitudinal prevention planning for Medicare beneficiaries and other populations who receive covered wellness services. The code underpins efforts to document prevention-focused encounters and Medicare-aligned care planning across ambulatory settings.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of reimbursement and billing benchmarks, common billing practices, policy and coverage considerations relevant to wellness and PPS services, and the clinical context for when G0439 is reported. The publication summarizes payer coverage patterns, notable policy updates affecting preventive visit billing, and practical considerations for service lines delivering annual wellness visits. Where input data is missing, the document notes that data is not available in the input. This national-focused brief is intended to inform coding, billing oversight, and operational planning related to preventive annual wellness visits with PPS documentation.
Billing Code Overview
HCPCS Level II code G0439 represents an annual wellness visit that includes a personalized prevention plan of service (PPS) and is billed for a subsequent visit. The service type is preventive, wellness visit with care planning. The typical site of service is ambulatory outpatient clinics or primary care offices where clinicians conduct preventative care visits and update personalized prevention plans.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
An established Medicare beneficiary returns to their primary care clinic for an annual wellness visit (subsequent visit) that updates the patient’s personalized prevention plan of service (PPS). The patient is an 72-year-old with hypertension, type 2 diabetes in good control, and a history of hyperlipidemia. The clinical workflow begins with pre-visit medication reconciliation and review of prior screening results. At arrival, nursing staff measure vitals, update problem list and medication list, and screen for falls, depression, cognitive impairment, and immunization status. The clinician conducts a focused history and review of health risk factors since the prior AWV, reviews preventive screening needs (colon cancer screening, pneumococcal and influenza vaccine status), updates the PPS, documents preventive services and referrals, and counsels on lifestyle risks. If appropriate, orders for laboratory screening or referrals are placed, and the clinician documents the elements required for an annual wellness visit subsequent to the initial AWV, billed with G0439.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day | When a distinct evaluation and management service is performed in addition to the AWV on the same day. |