Medical billing • Medicare preventive services • Updated September 2026
The phrase “annual physical” causes trouble in Medicare scheduling. A patient may use it casually, the appointment may be booked as a wellness visit, and only later does billing have to decide what was actually performed. For a returning Medicare wellness visit, the relevant code is G0439—not a routine physical-exam code.
People commonly search for “CPT code G0439,” but G0439 is not a CPT code. It is a HCPCS Level II code for a subsequent Medicare Annual Wellness Visit (AWV). The service is built around prevention: refresh the Health Risk Assessment, review current history and risks, look for possible cognitive concerns, and update the screening and prevention plan. A head-to-toe physical is not what defines the visit.
CMS’s current Annual Wellness Visit guidance lays out the subsequent-AWV requirements, frequency rules, same-day E/M policy, telehealth treatment, and the 2026 handling of G0136.
Most billing problems with G0439 are not caused by forgetting the code itself. They start earlier: the patient may not yet be due, the note may not show all of the AWV work, or a separate medical problem may be mixed into the wellness documentation without a clear distinction. Those are workflow issues, not code-book trivia.
G0439 at a Glance
| Question | Practical answer |
| What is G0439? | HCPCS Level II code for a subsequent Medicare Annual Wellness Visit. |
| Is it a routine physical? | No. The AWV develops or updates a personalized prevention plan; Original Medicare does not treat it as a routine comprehensive physical. |
| How often? | Once in a 12-month period after the initial AWV, subject to Medicare benefit history and eligibility. |
| First AWV code? | G0438. |
| Welcome to Medicare code? | G0402 for the Initial Preventive Physical Examination (IPPE) during the applicable first-year Part B window. |
| Specific diagnosis required? | No single diagnosis code is mandated by CMS; report a diagnosis consistent with the encounter. |
| Can a separate E/M be billed? | Yes, when the E/M service is significant, separately identifiable, medically necessary, and documented; append modifier 25 to the E/M code. |
| Telehealth? | CMS currently pays G0438 and G0439 when furnished via telehealth, if applicable requirements are met. |
| Main 2026 change? | G0136 now describes a standardized physical activity and nutrition risk assessment and may be furnished as an optional AWV element under CMS rules. |
What Is HCPCS Code G0439?
Use G0439 for a later Medicare Annual Wellness Visit after the beneficiary has already received the initial AWV. The word “subsequent” does real work here. G0439 is not the code for the first AWV, and it does not become appropriate merely because a patient is new to the practice.
Think of the AWV as a prevention-planning visit. The clinician reviews current risks and health information, looks for gaps in recommended preventive care, and updates a written prevention plan. That is different from performing a traditional comprehensive physical examination.
For the patient-facing explanation, Medicare’s Yearly Wellness Visit coverage page is especially clear: the AWV is used to create or update a personalized prevention plan and is not the same as a routine physical.
Is G0439 a CPT Code or a HCPCS Code?
G0439 belongs to HCPCS Level II, not CPT. The phrase “CPT code G0439” is common in online searches, but CMS classifies the code as HCPCS.
That distinction matters when staff are checking official references. CPT is maintained by the American Medical Association. HCPCS Level II contains alphanumeric codes used by Medicare and other payers for services and circumstances that are not represented only by CPT.
G0439 vs. G0438 vs. G0402
These three codes sit close together in Medicare preventive billing, but they are not interchangeable. G0402 is the Initial Preventive Physical Examination, G0438 is the first Annual Wellness Visit, and G0439 is used for later covered AWVs. The beneficiary’s Medicare history should decide which code fits the visit.
| Code | Service | When it applies | Common mistake |
| G0402 | Initial Preventive Physical Examination (IPPE), often called the Welcome to Medicare visit | During the beneficiary’s first 12 months of Medicare Part B coverage, subject to CMS rules | Using it as an annual code after the initial Part B period |
| G0438 | Initial Annual Wellness Visit | The beneficiary’s first Medicare AWV after becoming eligible for the AWV benefit | Billing it again because the patient changed practices or clinicians |
| G0439 | Subsequent Annual Wellness Visit | Later covered AWVs after the initial AWV | Treating “annual” as once per calendar year rather than checking the required interval and benefit history |
CMS separately describes the Initial Preventive Physical Examination and the Annual Wellness Visit. Before choosing G0402, G0438, or G0439, the practice should confirm which Medicare preventive benefit the beneficiary has already used.
G0439 Is Not a Routine Annual Physical
The confusion usually starts before the patient enters the exam room. Someone asks for an “annual physical,” while Original Medicare’s preventive benefit is the AWV. Staff should make that distinction clear when the visit is scheduled so the patient and clinician are expecting the same type of service.
A G0439 visit is mostly review and prevention planning. Medication and care-team information may be updated, current risks are discussed, cognitive concerns are considered, and the screening plan is revised as needed. None of that requires the visit to become a traditional head-to-toe physical exam.
MedIntelHub’s guide to what actually gets checked during an annual physical explains the difference from a patient’s perspective, including why a Medicare AWV should not be presented as an ordinary yearly physical.
A separate medical problem can still be handled at the same appointment. If the clinician goes beyond the AWV and performs a significant, separately identifiable, medically necessary problem-oriented E/M service, that additional work may be billed separately when the documentation supports it.
Who Is Eligible for G0439?
G0439 applies when the beneficiary has already used the initial AWV benefit and is now due for another covered AWV. The key question is the patient’s Medicare preventive-service history, not whether the patient is established with your office.
A person can be brand-new to a physician and still need G0439. If another clinician performed the patient’s first Medicare AWV, changing practices does not restart the benefit or create another initial AWV.
That is why two different ideas should not be blended together: “new patient” is an E/M relationship concept, while “initial AWV” refers to whether the Medicare beneficiary has already used that preventive benefit.
How Often Can G0439 Be Billed?
CMS applies a 12-month frequency rule to the AWV benefit. After the first AWV is billed with G0438, later covered AWVs use G0439 when the required interval has passed. CMS also bars an AWV within 12 months of the Initial Preventive Physical Examination, G0402.
The word ‘annual’ can be misleading. Medicare does not reset the AWV benefit on January 1. If the last covered AWV was in December, a new calendar year by itself does not make another one payable; the prior service date and benefit history still control the timing.
CMS has also treated AWV frequency as a compliance issue. Its Annual Wellness Visit: Incorrect Coding recovery-audit topic specifically addresses improper billing when another G0438 or G0439 was paid within the prior 12 months.
What Must Be Documented for a Subsequent AWV?
A subsequent-AWV note should show what was reviewed today and what changed, if anything. Templates are useful for keeping the required elements organized, but carrying forward last year’s checked boxes without a fresh review leaves little evidence that the current visit was actually completed.
1. Review and Update the Health Risk Assessment
The HRA can be completed before the appointment or during it. At a subsequent AWV, however, the point is to revisit the patient’s answers and bring them up to date, not simply move last year’s form into a new note.
That review goes well beyond diagnoses. Questions about day-to-day function, psychosocial concerns, behavioral risks, and other practical issues can change what belongs in the prevention plan. A completed form has little value if its answers are never used to shape the visit.
2. Bring Medical and Family History Up to Date
Look for what has changed since the last AWV. New diagnoses, surgery, medication changes, relevant family history, and substance exposure may all matter. A copied list is useful only after someone confirms that it still describes the patient today.
3. Update the Current Provider and Supplier List
CMS includes an updated list of current providers and suppliers among the subsequent AWV elements. That list can include behavioral health professionals and other clinicians or suppliers who regularly participate in the patient’s care.
A care-team list that was accurate last year may already be outdated. Specialists leave the picture, home-health services end, and new suppliers become involved. The AWV is a good place to correct that list so the prevention plan reflects the people actually participating in care.
4. Obtain the Required Routine Measurements
For the subsequent AWV, CMS lists weight, or waist circumference when appropriate, and blood pressure, along with other routine measurements considered appropriate based on the patient’s medical and family history.
The measurement requirements are not identical for the first and subsequent AWVs. That small difference is another reason to use the correct CMS checklist for the visit being performed instead of relying on one generic wellness template.
5. Check for Possible Cognitive Impairment
The clinician must assess for possible cognitive impairment. CMS allows this to draw on direct observation and information from the patient, family, friends, caregivers, or others. Brief cognitive tools may be considered, but the AWV cognitive element is not the same as a full diagnostic dementia evaluation.
If the AWV raises a concern about cognition, that finding does not automatically mean a separate cognitive-care service should be billed. Any additional service has its own requirements and needs its own documentation.
6. Update the Patient’s Screening Schedule
The written schedule should be updated around the patient’s age, health status, prior screening, risk profile, and current preventive recommendations. CMS points clinicians to USPSTF and ACIP recommendations when they are deciding what belongs on that schedule.
A useful schedule is selective. It should show what this patient is likely to need next and when, rather than reproducing a long list of every preventive service Medicare might cover.
7. Revisit Risks, Advice, and Referrals
The subsequent AWV also revisits the risks and conditions that could alter prevention planning. Mental health, substance use, cognition, and other concerns may lead to changes in advice or referral. The plan should reflect what was found at this visit, not a generic set of recommendations.
CMS lists several areas that may lead to advice or referral, including falls, nutrition, physical activity, tobacco use, social engagement, weight, and cognition. The point is not to document every category for every patient. The plan should respond to the risks actually identified.
8. Review Current Opioid Prescriptions and Screen for Substance-Use Risk
When a patient has a current opioid prescription, the AWV includes review of potential opioid use disorder risk factors, pain severity, the current treatment plan, non-opioid treatment information, and referral when appropriate. CMS also includes screening for potential substance use disorders as an AWV element.
A standardized tool may be used for substance-use screening, but CMS does not require one specific instrument for this AWV element.
Optional Services That May Be Added to the AWV
Some preventive services can be performed alongside the AWV and billed under their own rules. They are not automatic add-ons. Each service still has to meet its own eligibility, documentation, frequency, and claim requirements.
Advance Care Planning, When the Patient Wants It
Advance care planning is not required for every AWV. It is an optional discussion driven by the patient’s wishes. If it is performed and separately reported, the service still has to meet its own coding and documentation requirements.
Advance care planning has its own billing rules even when the discussion occurs during an AWV. CMS gives special cost-sharing treatment when the same AWV provider furnishes the service on the same day, reports it on the same claim, and uses modifier 33. When those conditions are met, the Part B deductible and coinsurance may be waived once per year; otherwise, the usual cost-sharing rules can apply.
2026 Change to G0136: Physical Activity and Nutrition Risk Assessment
For 2026, the AWV-related update that deserves the most attention is G0136. CMS repurposed the code. It no longer carries the earlier social-determinants-of-health risk-assessment meaning and instead describes a standardized physical activity and nutrition assessment.
For 2026, G0136 describes a standardized, evidence-based assessment of physical activity and nutrition that lasts 5–15 minutes. CMS allows it no more often than every six months, and it may be added to an AWV when the separate requirements are satisfied.
CMS confirms the revised 2026 treatment of G0136 in its May 2026 Evaluation and Management Services booklet as well as on the current AWV provider page.
When G0136 is furnished by the same AWV provider on the same day and placed on the same claim with modifier 33, CMS waives Part B deductible and coinsurance once per year. The code may be furnished every six months when its separate requirements are satisfied, so the frequency rule and the cost-sharing waiver are not the same thing.
A leftover 2025 template can quietly create a 2026 billing mismatch. If the EHR still labels G0136 as an SDOH assessment, the documentation may describe one service while the claim reports another. Smart phrases, charge rules, and staff reference sheets are worth checking before the old wording finds its way into new claims.
What Diagnosis Code Should Be Used With G0439?
CMS requires a diagnosis code on the AWV claim, but it does not prescribe one single ICD-10-CM diagnosis for every G0439 encounter. The diagnosis should fit the visit that was actually documented.
Z00.00 or Z00.01 may be reasonable when the documentation supports a general adult examination context, but they are not mandatory AWV diagnoses. Another diagnosis may fit better in a different encounter. The record—not an EHR default—should drive the choice.
Avoid hard-coding one diagnosis into every AWV template. If a separate medical problem is evaluated and managed during the same visit, that problem may need its own diagnosis on the E/M service as well.
Can G0439 and a Problem-Oriented E/M Visit Be Billed Together?
A separate E/M service can be billed on the same date as G0439, but only when there is genuinely separate problem-oriented work. CMS requires that service to be significant, separately identifiable, medically necessary, and supported by the record.
When those conditions are met, modifier 25 is appended to the office/outpatient E/M code. It does not belong on G0439.
Example: AWV Plus Separate Hypertension Management
Suppose a patient comes in for a due subsequent AWV. During the visit, the clinician also evaluates persistently elevated home blood-pressure readings, reviews medication adherence and side effects, changes the antihypertensive regimen, and creates a follow-up plan. If that additional work meets the requirements for a separately identifiable, medically necessary office E/M service, the claim may include:
- G0439 – subsequent Medicare Annual Wellness Visit
- Appropriate office/outpatient E/M code with modifier 25 – for the separately documented problem-oriented service
Choose the E/M level from the work documented for the medical problem under current E/M rules. Neither G0439 nor the mere presence of hypertension on the problem list tells you which E/M level is appropriate.
Example: Chronic Conditions Mentioned, but No Separate E/M
Picture a different visit: the patient’s chronic conditions are stable, and they come up only while the clinician updates the HRA, medication list, risk information, and prevention plan. No separate condition is assessed or managed. In that case, seeing hypertension or diabetes on the problem list does not, by itself, create another E/M service.
If the clinician really does provide both services, the distinction should be easy to find in the note. The record should show which problem required extra evaluation, what work went beyond the AWV, and what management decision resulted from that additional work.
What About G2211 on the Same Day?
Primary care practices also need to know about the G2211 exception. Since January 1, 2025, CMS has allowed G2211 with a qualifying office/outpatient E/M base code reported with modifier 25 when the same-day preventive service is an AWV.
That exception does not turn G2211 into a routine AWV add-on. The E/M service must qualify, and the longitudinal or condition-complexity work represented by G2211 must be supported independently.
Does the Patient Pay for G0439?
For a covered AWV, Medicare says the beneficiary owes no Part B deductible or coinsurance when the provider accepts assignment. That protection applies to the AWV benefit itself.
The rest of the appointment can be different. A separately billed E/M service, an additional test, or another service outside the preventive benefit may create cost sharing even though G0439 does not.
When a patient later sees separate charges on an insurance statement, MedIntelHub’s Explanation of Benefits guide can help explain allowed amounts, plan payments, and the portion that may become the patient’s responsibility.
A short explanation before the visit can prevent a billing surprise. If a separate medical problem is likely to be evaluated, patients should know that the problem-oriented portion of the appointment may be billed differently from the AWV.
Can G0439 Be Performed by Telehealth?
CMS currently pays G0438 and G0439 when the AWV is furnished through telehealth.
The format may be virtual, but the AWV requirements do not disappear. The practice still has to complete the required elements, document them, and use a workable process for information that would normally be gathered in person.
Telehealth policy is one of the areas most likely to change over time. Before relying on an old internal memo, check the current CMS telehealth list and billing instructions for the date of service.
Who Can Furnish an Annual Wellness Visit?
CMS permits an AWV to be performed by a physician, certain qualified non-physician practitioners, or a medical professional working as part of a team under the applicable rules. The person collecting pieces of the HRA is not necessarily the person who can independently bill the service.
The staff member who helps gather AWV information is not automatically the person who may furnish or bill the visit. Scope of practice, supervision, Medicare enrollment, and billing status still govern that question. The workflow should follow those rules rather than the permissions built into an EHR template.
FQHC Billing Is Different
FQHCs follow a different billing path. CMS uses G0468 for an FQHC visit that includes an IPPE or AWV together with the typical bundle of Medicare-covered FQHC services.
An FQHC should therefore use current FQHC guidance and its Medicare Administrative Contractor instructions rather than importing an ordinary professional-claim G0439 workflow without review.
G0439 Billing Examples
These scenarios are examples, not claim instructions for every situation. Confirm the patient’s benefit history, documentation, setting, and current CMS rules before submitting the actual claim.
| Scenario | Likely coding concept | What to verify |
| Patient had G0438 more than 12 months ago and returns for the next covered AWV | G0439 | Benefit history, all required subsequent-AWV elements, diagnosis consistent with encounter |
| Patient changed practices after previously receiving the initial AWV | Usually G0439 when due, not a new G0438 | Prior Medicare AWV history; new-to-practice status does not reset the AWV benefit |
| AWV plus separately managed uncontrolled diabetes | G0439 plus appropriate office E/M code with modifier 25, if requirements are met | Separate medical necessity, documentation, diagnoses, E/M level, patient cost sharing |
| AWV plus optional 2026 physical activity/nutrition assessment | G0439 plus G0136-33 when CMS conditions are met | Same day, same AWV provider, standardized evidence-based tool, frequency, documentation |
| AWV via telehealth | G0439 when the beneficiary is due and all requirements are met | Current telehealth rules, required AWV elements, documentation |
| FQHC performs AWV | FQHC-specific billing may use G0468 | Current FQHC and MAC rules rather than ordinary professional-claim assumptions |
Common G0439 Billing and Documentation Errors
G0439 denials often trace back to the way the visit was scheduled, documented, or checked for eligibility. The code itself is usually the easy part.
Submitting the Next AWV Before It Is Due
One of the easiest denials to prevent is an AWV submitted before the beneficiary is eligible again. Calendar-year logic is not enough. Whenever possible, verify the prior AWV date and Medicare benefit history before the appointment is completed.
Using G0438 Because the Patient Is New to the Practice
Being new to a physician does not make the Medicare AWV “initial” again. If the patient already received G0438 elsewhere, the next covered AWV is subsequent and is reported with G0439 when due.
Treating the AWV Like a Routine Physical
A physical-exam template can be a poor fit for an AWV. It may leave out required prevention-planning elements while also encouraging services that are not part of Medicare’s wellness benefit. Use an AWV-specific workflow instead.
Reusing Last Year’s HRA
Do not assume last year’s HRA answers are still current. Functional status, psychosocial and behavioral risks, safety concerns, and other responses should be checked again for the present visit, with changes reflected in the record.
Documenting Cognition With Only a Checkbox
A single “normal cognition” checkbox may say too little about what the clinician considered. The note can briefly record the clinician’s observations, concerns reported by the patient or others, and any brief tool that was used.
Adding Modifier 25 by Habit
Seeing G0439 on a claim is not, by itself, a reason to add modifier 25. The modifier belongs on a separate E/M code only when the clinician performed and documented additional work that is significant, separately identifiable, and medically necessary.
Overlooking Cost Sharing for Extra Services
A covered AWV can cost the patient nothing for G0439 while other work from the same appointment still creates cost sharing. That is why it helps to explain, before the visit, that a separately addressed medical problem or another billable service may appear as an additional charge.
Leaving the Old G0136 Description in the Workflow
For 2026 dates of service, an EHR that still defines G0136 as an SDOH risk assessment is using outdated language. The code now refers to a standardized physical activity and nutrition assessment. Templates, cheat sheets, charge logic, and staff training should all reflect that new description.
When a G0439 claim is denied, read the remittance first and compare it with the beneficiary’s preventive-service history. Refiling the same claim without knowing why it failed can repeat the problem. MedIntelHub’s claim denials prevention and follow-up checklist offers a broader approach to denial follow-up instead of treating every denial as a simple resubmission problem.
Practical G0439 Billing Checklist
- Confirm the patient has already received the initial AWV before using G0439.
- Verify the patient is due under Medicare AWV frequency rules and check prior G0402/G0438/G0439 history.
- Review and update the HRA rather than relying on an unchanged prior-year form.
- Update medical, surgical, family, medication, supplement, and substance-exposure history as appropriate.
- Update the current provider and supplier list.
- Document required measurements for the subsequent AWV.
- Assess for possible cognitive impairment.
- Update the written screening schedule and personalized prevention plan.
- Review current opioid prescriptions when applicable and screen for potential substance-use disorders.
- Report a diagnosis code that is consistent with the encounter; do not force a single diagnosis on every AWV.
- If a separate medical problem is managed, confirm that a distinct E/M service is medically necessary and documented before adding an E/M code with modifier 25.
- If using G2211 with a same-day E/M service, confirm the separate G2211 requirements are met.
- For G0136 in 2026, use the updated physical activity and nutrition assessment rules and apply modifier 33 only when CMS conditions for the AWV add-on are satisfied.
- Explain potential cost sharing for services outside the AWV preventive benefit.
- For telehealth, FQHC, or other special settings, verify current setting-specific CMS and MAC instructions.
What Changed in 2026?
G0439 did not become a new code in 2026. The notable change around the AWV is what happened to G0136.
CMS gave G0136 a new 2026 description focused on a standardized physical activity and nutrition assessment. The service lasts 5 to 15 minutes and may be reported no more often than every six months when its requirements are met.
CMS summarized the G0136 change in its Calendar Year 2026 Medicare Physician Fee Schedule final-rule summary, and the current AWV page now reflects the new description and billing instructions.
Another policy to keep in view during 2026 is the G2211 exception that took effect in 2025. A qualifying office/outpatient E/M service performed on the same day as an AWV may support G2211 even when the E/M code carries modifier 25, provided the separate G2211 requirements are met.
For context on why annual coding updates should trigger template and workflow review rather than a simple code swap, see MedIntelHub’s 2026 CPT code changes overview.
Frequently Asked Questions About G0439
Is G0439 a CPT code?
No. G0439 is a HCPCS Level II code. Calling it a CPT code is common in search queries, but CMS identifies it as HCPCS.
What does G0439 mean?
G0439 reports a subsequent Medicare Annual Wellness Visit and includes an updated personalized prevention plan of service.
What is the difference between G0438 and G0439?
G0438 is used for the beneficiary’s first Medicare AWV. G0439 is used for later covered AWVs after that initial visit.
Is G0439 the same as an annual physical?
No. The Medicare AWV is built around risk review and prevention planning. It is not the same thing as a routine comprehensive physical examination.
How often can G0439 be billed?
CMS applies a 12-month interval to the AWV benefit. G0438 or G0439 should not be billed again within that period, and an AWV should not be billed within 12 months of G0402.
Can G0439 be billed for a patient who is new to my practice?
Yes, if the beneficiary has already used the initial AWV benefit and is now due for a subsequent AWV. Being new to the practice does not restart the benefit.
Does Medicare require a specific ICD-10-CM code with G0439?
No single ICD-10-CM diagnosis is required for every G0439 claim. CMS requires a diagnosis code that is consistent with the encounter.
Can I bill 99213 or 99214 with G0439?
Yes, sometimes. A separate office/outpatient E/M service may be payable when the work is significant, separately identifiable, medically necessary, and documented. Modifier 25 goes on the E/M code.
Does modifier 25 go on G0439?
No. If a separate E/M service qualifies, modifier 25 is appended to that E/M code, not to G0439.
Can G2211 be billed with an E/M service on the same day as G0439?
Potentially. CMS allows G2211 with a qualifying office/outpatient E/M base code carrying modifier 25 when the same-day preventive service is an AWV, but G2211 still has to meet its own requirements.
Can G0439 be done by telehealth?
Yes. CMS currently pays G0438 and G0439 when the AWV is furnished through telehealth and the applicable Medicare requirements are satisfied.
Does the patient have a copay for G0439?
For the covered AWV itself, the Part B deductible and coinsurance do not apply when Medicare’s conditions are met. Separate services performed at the same appointment may create patient cost sharing.
What changed with G0136 in 2026?
In 2026, CMS changed G0136 to a standardized physical activity and nutrition assessment. It can be furnished as an optional AWV element when the specific billing and frequency rules are met.
Is advance care planning included in G0439?
Advance care planning is optional and depends on the patient’s wishes. When it is separately reported on the same day by the same AWV provider under CMS rules with modifier 33, cost sharing may be waived once per year.
Which Denial Reason Shows Up Most Often With G0439?
Timing is one of the first things to check when G0439 is denied. The prior AWV may have been too recent, or the claim may have used the wrong Medicare preventive-service code. Start with the remittance message and the beneficiary’s benefit history, then decide whether the claim needs correction, appeal, or resubmission.
Before the G0439 Claim Goes Out
G0439 is not a catch-all code for a yearly checkup. It reports a subsequent Medicare Annual Wellness Visit—a prevention-focused encounter built around current risks, screening needs, and an updated prevention plan.
Many preventable G0439 denials are created before a coder ever touches the claim. Confirm that the beneficiary is actually due, check which AWV benefit was used previously, and make sure today’s note documents today’s required work rather than last year’s copied-forward language.
One 2026 item deserves a separate check: G0136. The code now describes a standardized physical activity and nutrition assessment. An office that still uses the older SDOH wording can end up with documentation that no longer matches what is being billed.
Before filing, compare the claim with the visit itself. Eligibility should be current, the AWV elements should be visible in the note, any problem-oriented care should stand on its own, and the CMS instructions should match the date and setting of service.
Resources
Centers for Medicare & Medicaid Services – Annual Wellness Visit
CMS provides the current provider requirements for first and subsequent AWVs, including required elements, coding, diagnosis, same-day E/M billing, telehealth, advance care planning, and G0136 rules.
Medicare.gov – Yearly Wellness Visits
Medicare.gov explains beneficiary eligibility, costs, frequency, and the difference between an Annual Wellness Visit and a routine physical examination.
Medicare.gov: Yearly Wellness Visits
CMS – Medicare Wellness Visits
CMS summarizes the difference between the IPPE, AWV, and routine physical exam for providers.
CMS – Evaluation and Management Services, May 2026
The CMS MLN booklet includes 2026 guidance on G0136 and current policy for G2211 when an office/outpatient E/M service with modifier 25 is performed on the same day as an AWV.
CMS: Evaluation and Management Services
CMS – CY 2026 Medicare Physician Fee Schedule Final Rule Summary
CMS summarizes the 2026 change to the G0136 descriptor and other Physician Fee Schedule updates.
CMS: CY 2026 PFS Final Rule Summary
CMS – Annual Wellness Visit: Incorrect Coding
CMS identifies incorrect AWV frequency billing as a Medicare Fee-for-Service recovery-audit issue.
Editorial Guidelines & Medical Disclaimer
This article is for general educational and informational use. It explains Medicare Annual Wellness Visit coding and billing concepts, but it is not a substitute for the current CMS manuals, Medicare Administrative Contractor instructions, or professional coding advice for a specific claim.
Medicare instructions change over time, especially in areas such as telehealth, supervision, payment, and cost sharing. For the actual claim, use the current HCPCS code set, verify the beneficiary’s preventive-service history, and check the CMS, MAC, or facility instructions that apply to that date of service.
Clinical decisions belong to the treating healthcare professional and should reflect the individual patient’s needs. Nothing in this article diagnoses a condition or directs patient-specific treatment.
MedIntelHub develops medical and billing content from authoritative sources and reviews it for accuracy and clarity. Our Editorial Policy explains how sourcing, updates, and corrections are handled.
David Bennett
David Bennett is an author at MedIntelHub, where he creates clear, practical, and well-researched content about healthcare, medical billing, insurance, and patient education. His goal is to make complex healthcare topics easier for readers to understand and use in everyday situations. David emphasizes accuracy, transparency, and reliable sourcing, using information from trusted organizations and official healthcare resources whenever possible. Content published by David is intended for educational purposes and should not replace advice from qualified medical, legal, or healthcare professionals.