G0438 HCPCS code: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0438 is the HCPCS Level II code for annual wellness visit; includes a personalized prevention plan of service (pps), initial visit. In 2024 Medicare paid an average of $150.00 per service for G0438 across 676,884 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume fell 7% from 2022 to 2024 (726,745 to 676,884 services). In 2024, about 98,478 clinicians billed Medicare for G0438 for 676,883 beneficiaries; California, New York, Florida accounted for 24% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 13 |
| BETOS category | M5D |
| Added | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills G0438 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 98,478 |
| Medicare beneficiaries | 676,883 |
| States with claims | 56 |
| Share of services in top 3 states (California, New York, Florida) | 24% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0438, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 726,745 | 726,744 | $154.21 | $154.21 |
| 2023 | 698,209 | 698,209 | $150.68 | $150.68 |
| 2024 | 676,884 | 676,883 | $150.00 | $150.00 |
States with the most G0438 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 67,357 | $165.22 |
| New York | 48,170 | $166.27 |
| Florida | 46,147 | $153.15 |
| Texas | 37,249 | $153.83 |
| Pennsylvania | 36,124 | $142.45 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for G0438
- 2011-01-01: G0438 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0438?
G0438 is the HCPCS Level II code for annual wellness visit; includes a personalized prevention plan of service (pps), initial visit. Short descriptor: "Ppps, initial visit".
How much does Medicare pay for G0438?
In 2024, the average Medicare payment was $150.00 per service (average allowed $150.00).
Does Medicare cover G0438?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G0438 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G04 codes
- G0400 — Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
- G0402 — Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
- G0403 — Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
- G0404 — Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
- G0405 — Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
- G0406 — Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
- G0407 — Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
- G0408 — Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
- G0409 — Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
- G0410 — Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0411 — Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes
- G0412 — Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
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Next steps
- Run a reimbursement report for a device billed under G0438
- Watch G0438 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0438
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.