Time threshold & code combinations

Billed once per patient, not recurring; must be at least 12 months after Part B enrollment or the IPPE.

• Mutually exclusive with G0439, only one AWV type is billed per year and only one initial AWV per patient, ever
• Can be billed the same day as 99497/99498 (Advance Care Planning) or G0506 (CCM initiating visit add-on) if those services are also furnished

Who can bill

• Physicians
• Non-physician practitioners (nurse practitioners, physician assistants, and similar)
• A medical professional (including a health educator, registered dietitian, or nutrition professional) working under the direct supervision of a physician

Eligibility & billing requirements

• Patient has not had an AWV before
• At least 12 months have passed since Part B enrollment or the one-time IPPE, if one was performed
• Health Risk Assessment completed
• Full medical/family/social history and current medication review
• Routine measurements and cognitive impairment screening
• Written personalized prevention plan provided to the patient

When to use it

Documentation checklist

• Health Risk Assessment
• Full history and medication review
• Cognitive screening results
• Written prevention plan

Common billing mistakes

• ✕Billing G0438 within 12 months of Part B enrollment or the IPPE
• ✕Billing G0438 a second time for the same patient (should be G0439 for any AWV after the first)