Reimbursement
$121.75
Threshold
N/A
2026 Status
Active
What is CPT Code G0439?
CPT G0439 is defined as: Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit. This service includes a Health Risk Assessment (HRA), updated medical and family history, list of current providers, and screening for cognitive impairment.
This code is primarily used for Preventive services. It falls under the category of Evaluation and Management (E/M) - Preventive and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.5
Physician Effort
PE (Non-Fac)
1.99
Practice Expense
Malpractice
0.155
Risk Factor
Total RVU
3.645
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
social determinants link
2026 guidelines encourage bundling G0442 (Alcohol screening), G0444 (Depression screening), and G0136 (SDOH) with G0439 for comprehensive care.
deductible waiver
AWV remains covered at 100% by Medicare (no patient out-of-pocket cost).
virtual care bridge
AWV is the primary vehicle for identifying patients eligible for CCM, RPM, and BHI programs.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
No fixed time; based on completion of all PPPS elements
staff type
Physician, Nurse Practitioner, Physician Assistant, or Clinical Nurse Specialist
frequency
Once every 12 months (at least 366 days after the last AWV)
add on codes
G0136 (Social Determinants of Health Risk Assessment)
care plan requirement
Personalized Prevention Plan of Service (PPPS) including a 5-10 year screening schedule.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is increasing the weighting of AWV completion in MIPS and ACO quality rankings for 2026.
Common Clinical Scenarios
CMS Eligibility: Open to all Medicare beneficiaries who have had Part B for 12+ months. Annual
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS G0438
G0438 is for the FIRST annual wellness visit; G0439 is for all subsequent years.
VS 99397
99397 is an age-based preventive visit covered by commercial insurance but NOT by Medicare (which uses G0439).
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