G0438 — Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0438 is a HCPCS Level II code for annual wellness visit; includes a personalized prevention plan of service (pps), initial visit. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 2.60
- PE (non-facility)
- 2.45
- PE (facility)
- 2.45
- Malpractice RVU
- 0.17
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G0438 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G0438
- Long descriptor
- Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
- Short descriptor
- Ppps, initial visit
- Added
- January 1, 2011
- BETOS
- M5D
- Pricing indicator
- 11 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established using national RVUs.
Codes adjacent to G0438
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0438 is not quite right, the correct code is very often within a few positions of it.
- G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
- G0431Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounterterminated
- G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
- G0433Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
- G0434Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounterterminated
- G0435Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
- G0436Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutesterminated
- G0437Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutesterminated
- G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
- G0442Annual alcohol misuse screening, 5 to 15 minutes
- G0443Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- G0444Annual depression screening, 5 to 15 minutes
- G0445High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
- G0446Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
- G0447Face-to-face behavioral counseling for obesity, 15 minutes
- G0448Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing
Questions about G0438
What is HCPCS code G0438?
G0438 is a HCPCS Level II code for annual wellness visit; includes a personalized prevention plan of service (pps), initial visit. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0438?
The CMS HCPCS file marks G0438 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0438 paid under the physician fee schedule?
G0438 carries PFS status code A. Active code. Paid separately under the physician fee schedule.