Quick Answer: When Can G0438 Be Billed?

Can you bill g0402 and g0438 together?

Annual Wellness Visits can be for either new or established patients as the code does not differentiate.

The initial AWV, G0438, is performed on patients that have been enrolled with Medicare for more than one year.

This exam is billed using HCPCS code G0402..

What is the difference between g0438 and g0439?

As a reminder, there are two codes related to the AWV: G0438 (includes a personalized prevention plan of service, initial visit) and G0439 ( includes a personalized prevention plan of service, subsequent visit).

How Much Does Medicare pay for g0438?

The HCPCS code to bill for this service is G0438, “Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit,” reimbursed at an average rate of $173.70. A health risk assessment (HRA) must be completed with the visit.

Can you bill g0438 with 99213?

Medicare does discourage this and says there is too much ‘crossover’ between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.