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For 2026, the Annual Wellness Visits (AWV) program has some very exciting increases to reimbursement rates! In this video, we dive into everything you need to know so that you can properly code and bill for this program.
There are no major changes to the AWV program rules and regulations in CMS's 2026 Final Rule. But, there are the increased reimbursement rates for the year. With these increased rates, it's a great time to grow or start an AWV program. The CPT codes we’ll discuss are based on national averages, which may vary in your area. For the exact current rate based on your location, visit the Physician Fee Schedule website.
What is an Annual Wellness Visit?
An Annual Wellness Visit is a yearly appointment designed to develop or update a personalized prevention plan based on a patient’s current health and risk factors. Unlike a traditional physical exam, the AWV focuses on preventive care, risk assessment, and long-term wellness strategies rather than diagnosing or treating specific medical conditions.
There are three types of AWVs based on when the visit occurs and each has its own CPT code.
CPT Code G0402
First is the the Initial Preventive Physical Examination, or IPPE, and its billing code G0402. This code can only be billed during the patient’s first 12 months of their enrollment in Medicare Part B and is considered a “once in a lifetime” assessment. If a patient misses the initial eligibility period, they will not qualify for the IPPE and will instead proceed with the Initial Annual Wellness Visit. The current national average reimbursement for G0402 is $175.
CPT Code G0438
The next type of AWV is the Initial Annual Wellness Visit, and its billing code G0438. The Initial AWV can only be done 12 months after an IPPE, or after 11 months of Medicare enrollment if the patient misses that initial IPPE eligibility window. The current national average reimbursement for G0438 is $174.
CPT Code G0439
And the final AWV is the Subsequent Annual Wellness Visit and its billing code G0439. The Subsequent AWV is the yearly follow-up to an Initial AWV and can be completed 11 months after the Initial AWV, and then every 11 months thereafter. The current national average reimbursement for G0439 is $138.
There are additional services that can be offered with AWVs, like Advance Care Planning and Social Determinants of Health. These additional offerings can enhance patient engagement and provide further reimbursement opportunities.
With the reimbursement increases this year, there’s a great opportunity to grow your program and offer Annual Wellness Visits to more patients. Reach out to ThoroughCare if you need help in starting or growing your AWV program.
