Preventive care
G0438 — Annual wellness visit, personalized prevention plan; initial visit
This is the Medicare-specific code for the first Annual Wellness Visit (AWV) — a free benefit for Medicare beneficiaries after the first 12 months of Part B coverage.
- Typical setting: Doctor's office
- National avg charge (illustrative): $155-$195 Medicare allowed (approx. $166 national Medicare average; $0 patient cost when provider accepts assignment)
- Most-disputed reason: Billing G0438 more than once: G0438 is a once-per-lifetime benefit — all subsequent annual wellness visits must use G0439
What it means
What G0438 actually means
This is the Medicare-specific code for the first Annual Wellness Visit (AWV) — a free benefit for Medicare beneficiaries after the first 12 months of Part B coverage. The visit creates a personalized prevention plan, includes a health risk assessment, and screens for cognitive impairment, depression, and fall risk. It is distinct from a routine physical exam and has no patient cost-sharing.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing G0438 more than once: G0438 is a once-per-lifetime benefit — all subsequent annual wellness visits must use G0439
- Confusing IPPE and AWV: billing G0438 instead of G0402 for the 'Welcome to Medicare' visit within the first 12 months of Part B enrollment
- Incomplete HRA documentation: claiming G0438 without the required Health Risk Assessment elements including demographic data, self-assessment of health, psychosocial risks, ADLs, and a written screening schedule
If you see G0438 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on G0438 often also see these adjacent codes on the same bill.
HCPCS
G0011 — Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes
Hiv prep counsel, md 15-30m
HCPCS
G0012 — Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle
Injection of hiv prep drug
Related BillBusted guides
Plain-English reads if you see G0438 on a bill.
G0438 FAQ
Plain-English answers.
What does G0438 usually cost?
$155-$195 Medicare allowed (approx. $166 national Medicare average; $0 patient cost when provider accepts assignment). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on G0438?
Billing G0438 more than once: G0438 is a once-per-lifetime benefit — all subsequent annual wellness visits must use G0439
What should I do if I see G0438 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to G0438 before paying.
Don't pay G0438 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.