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Annual Wellness Visit (AWV) CPT Code by Age in 2025
Annual Wellness Visits (AWVs) are preventive health checkups covered by Medicare to ensure patients stay healthy.
These visits focus on reviewing overall health, identifying risks, and planning future care. Healthcare providers use specific CPT (Current Procedural Terminology) codes to bill these visits based on the patient’s age and visit type. Let’s break it down.
An Annual Wellness Visit is not a physical exam. Instead, it includes discussions about your health history, screening for risks, and creating a personalized prevention plan. Medicare covers these visits, but they must follow specific billing rules.
Why Are CPT Codes Important?
Healthcare providers use CPT codes to document and bill Medicare for services. Each code corresponds to a specific service, ensuring accurate billing and payment. For AWVs, these codes change depending on the patient’s age or visit type.
Medicare Annual Wellness Visit CPT Code by Age in 2025
Annual Wellness Visits (AWVs) for Medicare patients utilize specific CPT codes that vary by the patient’s enrollment period in Medicare. Here are the relevant codes and their applications as of 2025:
- G0402: This code is for the Initial Preventive Physical Exam (IPPE), which is a one-time visit available to new Medicare enrollees within their first 12 months. It includes basic health assessments but is not classified as an AWV.
- G0438: This code is used for the initial Annual Wellness Visit after the first 12 months of Medicare enrollment. Patients can schedule this visit on or after the first day of the calendar month in which they reach their one-year mark of enrollment.
- G0439: This code applies to all subsequent Annual Wellness Visits following the initial visit. It can be billed once per calendar year after any previous AWV has been conducted.
- G2211: As of 2025, providers can also bill this code in conjunction with AWVs when incorporating comprehensive primary care into an evaluation and management (E&M) visit for Medicare patients
Adults (Ages 40-64)
Younger Adults (Ages 18-39)
- 99385: Used for new patients, this code documents preventive evaluations.
- 99395: This code is for established patients, also focusing on preventive care but typically not categorized as wellness visits under Medicare guidelines
- 99386: This code is for new patients in this age range, focusing on preventive evaluations.
- 99396: This code applies to established patients aged 40-64, allowing for screenings and assessments tailored to age-specific risks.
Additional Notes
- For patients newly enrolled in Medicare, the initial preventive physical examination (IPPE) is billed using G0402, but this is distinct from AWVs and only applicable within the first 12 months of enrollment.
- Other codes like 99497 and 99498 may apply if additional time is spent on advanced care planning during an AWV.
What Do These Visits Include?
Each wellness visit may include:
- Reviewing medical history and family health risks.
- Screening for depression or cognitive issues.
- Planning immunizations or routine screenings.
- Creating a personalized health plan.
What’s Not Covered in an AWV?
Medicare AWVs don’t cover a physical exam or treatment for specific issues. If additional services are provided, they may require separate CPT codes and billing.
Key Points to Remember
- Use G codes (G0402, G0438, G0439) for Medicare beneficiaries.
- Use 99385-99397 for non-Medicare patients based on age and visit type.
- Proper coding ensures accurate billing and Medicare compliance.
What ICD-10 codes are used for the initial and subsequent Annual Wellness Visits?
ICD-10 Codes for Annual Wellness Visits
- Z00.00: This code is used for a general adult medical examination without abnormal findings. It indicates that the wellness visit did not reveal any issues.
- Z00.01: This code is for a general adult medical examination with abnormal findings. It is applicable when any abnormalities are noted during the visit.
Conclusion
Annual Wellness Visits are essential for preventive care, helping patients and providers stay ahead of health risks. Primary care physicians can ensure smooth billing and focus on delivering quality care by understanding the correct CPT codes based on age and visit type.
