The Medicare Annual Wellness Visit (AWV) bills as G0438 for a patient's first AWV and G0439 for each one after, once every 12 months. In 2026 they pay about $174 and $138 (national non-facility amounts). Patients pay nothing if you accept assignment. The 2026 change: the optional SDOH assessment is gone, and G0136 now covers physical activity and nutrition.
Takeaways
Three codes, three moments
G0402 is the Welcome to Medicare visit in the first year of Part B. G0438 is the first AWV, once per lifetime. G0439 is every AWV after that.
No cost to the patient
No coinsurance and no Part B deductible when you accept assignment. That's your best booking line.
2026 swapped one optional element
The SDOH risk assessment is out. A physical activity and nutrition assessment is in, billed with the redefined G0136.
The AWV is a planning visit, not a physical
Don't promise patients an exam. Do use the visit to close care gaps and document chronic conditions.
Who is eligible
Under 42 CFR 410.15, a patient qualifies for an AWV when both are true:
- They are more than 12 months past the start of their first Part B coverage.
- They haven't had an IPPE or AWV in the past 12 months.
The IPPE is the "Welcome to Medicare" preventive visit. Medicare.gov says it happens "once within the first 12 months you have Part B." Patients don't need an IPPE to qualify for an AWV later. Read our AWV glossary entry for a quick definition.
G0438 vs G0439 vs G0402
| Feature | Code and timing | 2026 national amount |
|---|---|---|
| G0402 (IPPE) | Once, within the first 12 months of Part B | About $175 |
| G0438 (initial AWV) | Once per lifetime, after the first 12 months of Part B | About $174 |
| G0439 (subsequent AWV) | Once every 12 months after the initial AWV | About $138 |
These are 2026 national non-facility amounts. Your locality will differ, so check the CMS PFS Look-Up Tool.
Cost-sharing. Medicare.gov says the patient pays nothing if the provider accepts assignment, and the Part B deductible doesn't apply. Extra tests or services at the same visit can carry coinsurance. Tell the patient that up front.
Adding a problem visit. CMS says that when you also provide "a significant, separately identifiable, medically necessary" E/M service, you may bill it. Report the E/M code with modifier 25. That one does carry cost-sharing.
Advance care planning (ACP). ACP is optional within the AWV. CMS waives the patient's cost-sharing for ACP (99497) when four things are true. It's on the same day as the AWV, by the same provider, billed with modifier 33, on the same claim.
Required elements
The first AWV (G0438) must include these elements under 42 CFR 410.15:
- Health risk assessment (HRA), a structured questionnaire the patient fills out
- Medical and family history
- List of current providers and suppliers
- Height, weight, BMI and blood pressure
- Detection of cognitive impairment
- Review of depression risk
- Review of functional ability and safety
- A written screening schedule for the next 5 to 10 years
- A list of risk factors and the interventions planned for them
- Personalized health advice and referrals
- Review of current opioid prescriptions
- Screening for substance use disorders
- Advance care planning, at the patient's discretion
The subsequent AWV (G0439) updates the same items. It reviews the HRA, updates history, providers and the screening schedule, takes measurements, and repeats cognitive and substance use screening.
What changed in 2026
Two linked changes, both optional elements.
SDOH assessment removed. In 2024, CMS added an optional social determinants of health (SDOH) risk assessment to the AWV. The current eCFR no longer lists it.
Physical activity and nutrition added. In its place is an optional "Physical Activity and Nutrition Risk Assessment that is standardized and evidence-based." It's furnished at the discretion of the clinician and the patient.
G0136 redefined. CMS kept the code but rewrote it. The 2026 descriptor reads: "Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months." If your templates still map G0136 to an SDOH screen, fix them now.
AWV vs annual physical
Patients ask for "my physical." The AWV isn't one. Medicare.gov calls it "a conversation-based visit with your doctor or other health care provider to create a prevention plan. It isn't a routine physical exam." Original Medicare doesn't cover routine physicals.
Say this clearly when booking. A patient who expects a head-to-toe exam and gets a questionnaire will be unhappy. A patient told "this is your free yearly planning visit" won't be.
Why the AWV anchors risk adjustment and care gaps
The AWV is often the one scheduled, unhurried visit a Medicare patient has each year. Two value-based programs lean on it.
Risk adjustment. In Medicare Advantage and ACOs, payment and benchmarks are adjusted for how sick patients are. Diagnoses drive that adjustment, and they reset every year. A chronic condition has to be documented from a face-to-face encounter each year to count. The AWV, often paired with a problem-oriented E/M, is a natural place to assess and document chronic conditions. Our risk adjustment year-end checklist covers this.
Care gap closure. The 5-to-10-year screening schedule is a built-in care gap review. Colorectal and breast cancer screening, depression screening and blood pressure control all show up in quality measures. See our care gap glossary entry.
How to book more AWVs
The AWV is free to the patient and pays the practice. The constraint is getting patients on the calendar.
- 1
Build the eligible list
Pull Medicare patients with no G0438 or G0439 in the last 12 months, and new Medicare patients past their first year of Part B.
- 2
Sort by value
Put patients with open care gaps, chronic conditions not yet documented this year, and no visit this year at the top.
- 3
Reach out with the right message
Lead with no cost to them. Set expectations that it's a planning visit.
- 4
Get them to a scheduler
Transfer interested patients to whoever books, or log a callback task.
- 5
Track completion
Compare booked and completed AWVs against the eligible list. Re-queue no-shows.
Rivvi helps with steps 1, 2 and 5 in the free workspace. Upload your patient list and billing export, and ask who hasn't had an AWV in 12 months. Uploads are enriched against CMS and NPI registry data. On the Team plan, Rivvi handles steps 3 and 4. It calls or texts patients in English, Spanish and 30 more languages. When a patient wants to book, it warm-transfers them to your front desk, or creates a follow-up task if no one is free. Rivvi doesn't book directly into your EHR. Outcomes are logged and pushed to a connected CRM. Learn more on our care gap closure page.
Find every patient due for an AWV
Upload your patient list and see who's due, who has gaps, and who to call first. Free for you and two colleagues, with a HIPAA BAA.
Sources
- eCFR: 42 CFR 410.15, Annual wellness visits
- Medicare.gov: Yearly Wellness Visits
- Medicare.gov: Welcome to Medicare Preventive Visit
- CMS: Annual Wellness Visit
- CMS MLN909289: Advance Care Planning (March 2026)
- CGS Medicare: Annual Wellness Visit Fact Sheet
- AMA: 2026 Medicare Physician Fee Schedule Final Rule Summary
- UTMB: G0136, New Definition for 2026
- Noridian: AWV SDOH Risk Assessment (MM13486)
- MedFeeSchedule: 2026 national amounts (G0438, G0439, G0402)
- CMS Physician Fee Schedule Look-Up Tool