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G0439
Description, Billing Rules, and Use Cases

HCPCS G0439 is used to bill a subsequent Annual Wellness Visit (AWV) for Medicare Part B beneficiaries. It may be performed once per calendar year, starting 12 months after the initial AWV (G0438) or a previous G0439 service. This visit focuses on updating the patient’s Personalized Prevention Plan (PPPS) and reassessing risk factors.

What is HCPCS Code G0439?

G0439 represents the annual follow-up AWV covered by Medicare. Unlike routine physical exams, the G0439 visit emphasizes prevention, care coordination, and risk factor surveillance. It is designed to be a no-cost benefit for Medicare patients.

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Key elements of the G0439 service include:

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  • Update of the Health Risk Assessment (HRA)

  • Review and update of:

    • Medical and family history

    • List of providers and medications

    • Functional status and safety screening

  • Repeat screening for cognitive impairment and depression

  • Reassessment of risk factors and review of screening schedule

  • Revised Personalized Prevention Plan (PPPS)

 

G0439 may be billed once every 12 months following G0438 or the last G0439, and must follow all Medicare documentation guidelines.

G0439 Billing Requirements and Eligibility

G0439 is the code used for subsequent Annual Wellness Visits (AWVs) under Medicare. It may only be billed if the patient has already received an initial AWV (G0438) and at least 12 months have passed since the most recent AWV (either G0438 or G0439).

Patient Eligibility Criteria

To bill G0439, the patient must:

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  • Be enrolled in Medicare Part B

  • Have previously received a G0438 (initial AWV) or G0439 (subsequent AWV)

  • Have not received any AWV service (G0438 or G0439) in the past 12 months

  • Be past their first 12 months of Medicare Part B enrollment

  • Not have had a Welcome to Medicare Visit (G0402) in the current 12-month period

Who May Bill G0439

G0439 may be billed by the following Medicare-enrolled professionals:

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  • Physicians (MD/DO)

  • Nurse Practitioners (NPs)

  • Physician Assistants (PAs)

  • Clinical Nurse Specialists (CNSs)

 

The billing provider must:

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  • Be authorized to furnish E/M services

  • Be practicing within their licensed scope under state law

  • Personally supervise and/or document the service

Service Settings

G0439 may be provided in:

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  • Physician offices (POS 11)

  • Outpatient clinics, RHCs, and FQHCs*

  • Telehealth platforms (with appropriate modifiers and CMS compliance)

 

RHCs and FQHCs follow special payment methodologies and should refer to CMS-specific billing instructions for AWVs.

G0439 Billing Documentation Checklist

To support a compliant claim for G0439, the following documentation elements must appear in the medical record:

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  • Confirmation of eligibility:

    • Medicare Part B beneficiary

    • Prior AWV (G0438 or G0439) on record

    • No AWV billed in the past 12 months

    • Visit not occurring within 12 months of a G0402 (Welcome to Medicare)

  • Date and location of service:

    • Visit date must be clearly recorded

    • Include place of service (POS)

    • If delivered via telehealth, attach modifier 95 and follow CMS virtual care requirements

  • Updated Health Risk Assessment (HRA):

    • Review and revise patient-reported risks, functional limitations, and safety concerns

    • New risks or lifestyle factors documented as applicable

  • Updated personal and family medical history:

    • Note any new diagnoses, hospitalizations, or family risk factors

    • Revise history since prior AWV

  • Current provider and medication list:

    • Complete and up-to-date list of all healthcare providers and suppliers

    • Prescription and non-prescription medication list, including supplements

  • Reassessment of functional status and safety:

    • Activities of Daily Living (ADLs)

    • Fall history or risk factors

    • Home safety concerns or mobility limitations

  • Repeat screenings:

    • Cognitive impairment (e.g., memory, reasoning, orientation)

    • Depression risk (PHQ-2, PHQ-9, or equivalent)

  • Updated Personalized Prevention Plan (PPPS):

    • Screening schedule for eligible services (e.g., mammogram, colonoscopy, A1c)

    • Immunization plan (e.g., flu, COVID, shingles)

    • Community or wellness referrals as appropriate

G0439 Time Thresholds and Code Combinations

G0439 is not time-based, but it follows a strict 12-month frequency limit. It can only be billed once per year per beneficiary, and only after a previous G0438 or G0439 has been completed.

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Use the following chart to determine the correct billing code:

Table showing when to bill G0439 vs G0438, with frequency limits, telehealth guidance, and E/M substitution scenarios.

Key Reminders:

  • There is no required time duration, but the service must meet documentation depth for full AWV components

  • G0439 cannot be billed within 12 months of a prior AWV (G0438 or G0439)

  • G0439 should not be confused with a routine physical (which Medicare doesn’t cover)

  • May be delivered via telehealth under CMS virtual visit rules with modifier 95

When to Use G0439:
Common Scenarios and Use Cases

G0439 is used for subsequent Annual Wellness Visits (AWVs) under Medicare, beginning one year after the patient’s initial G0438. It must include a full update of the patient’s risk factors, screening schedule, and prevention plan.

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Here are examples of how G0439 is used in practice:

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  • Annual Medicare Wellness Visit – In-Person Office Setting
    A primary care physician:

    • Reviews last year’s personalized prevention plan and screening outcomes

    • Updates the HRA and confirms the patient’s new home safety risks

    • Adjusts colorectal screening schedule and adds pneumonia vaccine
      Billing: G0439

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  • Medicare AWV Follow-Up via Telehealth
    A nurse practitioner:

    • Conducts the full AWV virtually using a secure video platform

    • Performs depression and cognitive screening tools remotely

    • Emails the updated prevention plan with wellness referrals
      Billing: G0439 + modifier 95

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  • Subsequent AWV at Rural Health Clinic (RHC)
    A physician assistant:

    • Updates medication list, reviews sleep and fall risk

    • Flags new family history of cardiac disease

    • Documents updated PPPS and coordinates preventive labs
      Billing: G0439 (RHC-specific methodology applies)

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Common G0439 Billing Mistakes
(and How to Avoid Them)

Because G0439 is used annually for Medicare wellness services, most billing errors stem from timing violations, mistaken code reuse, or incomplete documentation.

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❌ Billing G0439 Without a Prior G0438 or G0439
G0439 is a follow-up AWV. It can’t be billed as a patient’s first wellness visit. If the patient has never had an AWV before, bill G0438 instead.

 

❌ Billing G0439 Before 12 Months Have Passed
Medicare requires 12 full months between any two AWVs (whether G0438 or G0439). Billing too early—even by a few days—can lead to denial.

 

❌ Substituting G0439 for a Routine Physical
Medicare does not cover annual physical exams. G0439 is strictly for preventive wellness planning. If a physical is done, document and bill a separate E/M service only if medically necessary, with modifier -25.

 

❌ Missing Required Elements (e.g., PPPS, HRA)
Failure to update the Health Risk Assessment (HRA) or provide an updated prevention plan can result in audit flags or payment takebacks.

 

❌ Telehealth Billing Without Modifier 95
If the AWV is done remotely, include modifier 95 and use a CMS-accepted telehealth POS. Documentation must confirm all components were completed virtually.

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