CPT Codes for Preventive Care Visits: Annual Wellness, AWV, and IPPE

Three Types of Preventive Visits—And Why They Are Not Interchangeable

Primary care physicians use three distinct preventive care visit code sets, depending on the patient's age, insurance type, and visit history. Confusing them creates billing errors and missed revenue:

1. Commercial preventive care codes (CPT 99381–99397): Used for non-Medicare patients with commercial insurance or Medicaid
2. Medicare Annual Wellness Visit (AWV): G0438 (initial) and G0439 (subsequent)—specific Medicare benefit with defined elements
3. Initial Preventive Physical Examination (IPPE): G0402—the "Welcome to Medicare" visit, once per lifetime

Commercial Preventive Care Codes (99381–99397)

New Patient Preventive Visits (99381–99387)

New Patient Preventive Care CPT Codes

Code	Age Range	Description
99381	Under 1 year	Infant preventive medicine evaluation, new patient
99382	1–4 years	Early childhood preventive medicine, new patient
99383	5–11 years	Late childhood preventive medicine, new patient
99384	12–17 years	Adolescent preventive medicine, new patient
99385	18–39 years	Young adult preventive medicine, new patient
99386	40–64 years	Middle-age adult preventive medicine, new patient
99387	65+ years	Senior preventive medicine, new patient

Established Patient Preventive Visits (99391–99397)

Established Patient Preventive Care CPT Codes

Code	Age Range
99391	Under 1 year
99392	1–4 years
99393	5–11 years
99394	12–17 years
99395	18–39 years
99396	40–64 years
99397	65+ years

Most commercial payers cover one preventive visit per year, with patient age determining the code. Document: comprehensive history, age-appropriate physical examination, counseling and anticipatory guidance, and ordering of age-appropriate preventive services.

Medicare Annual Wellness Visit (AWV)

The AWV is a distinct Medicare Part B benefit—not a physical exam. Medicare specifically prohibits billing a physical examination during an AWV because the AWV is a health risk assessment and prevention planning visit, not a clinical examination.

G0402: Initial Preventive Physical Examination (IPPE)

The IPPE ("Welcome to Medicare" visit) is available once in a Medicare beneficiary's lifetime, within the first 12 months of Medicare Part B enrollment. It is a distinct visit from the AWV.

Required IPPE elements:

• Review of medical and social history
• Review of potential risk factors for depression
• Review of functional ability and level of safety
• Physical examination (including measurement of height, weight, BMI, blood pressure, visual acuity)
• End-of-life planning discussion and referral if appropriate
• Written screening schedule and referral list
• Review of potential risk factors for depression

EKG: billed separately as G0403 (interpretation) + G0404 (tracing) + G0405 (limited interpretation) when an electrocardiogram is performed during IPPE.

G0438: Initial AWV (First AWV after the IPPE or after Part B enrollment)

Available once per calendar year, beginning 12 months after the IPPE or 12 months after Part B enrollment (whichever is applicable). No patient cost-sharing (no copay, no deductible).

Required AWV elements (G0438):

• Health risk assessment (HRA): standardized questionnaire addressing physical, mental, and cognitive health, behavioral risk factors, urgent health needs, social needs
• Establishment of or update to the patient's medical and family history
• Screening for potential cognitive impairment using a validated tool (MMSE, MoCA, or equivalent)
• Review of patient's functional ability and level of safety (ADLs, fall risk assessment)
• Establishment of or update to a comprehensive preventive care plan
• Written screening schedule (5–10 year plan) for preventive services
• List of risk factors and conditions with recommended interventions
• Documentation of current providers and suppliers

G0439: Subsequent AWV

Same as G0438 but after the first AWV. Can be billed once per calendar year (must be 12 months after the last AWV). Same covered elements as G0438.

Same-Day Problem Visit Billing (25 Modifier)

When a patient presents for a preventive care visit AND has a significant, separately identifiable problem that is addressed during the same encounter, you may bill both the preventive code AND a problem-focused E/M code on the same date of service—with modifier 25 appended to the E/M code.

Example: 45-year-old established patient presents for annual physical (99396). During the visit, the physician also addresses a new complaint of knee pain, orders an X-ray, and starts physical therapy. The knee pain assessment is a separate E/M service:

• Bill: 99396 (preventive visit, established, 40–64)
• Bill: 99213-25 or 99214-25 (problem-focused visit for knee pain, with modifier 25)

The modifier 25 signals to the payer that the E/M service was a significant, separately identifiable service—not just the preventive visit note with problem discussion. Without modifier 25, the payer will bundle and deny one of the two codes.

Documentation requirement: The note must have a clearly separate assessment and plan section for the problem-focused service, distinct from the preventive care documentation. The problem cannot simply be mentioned in the preventive note's review of systems—it must be documented as a separate clinical decision-making element.

AWV + Problem Visit Billing

The same modifier 25 rule applies to AWV visits. If a patient has a significant problem addressed at the AWV, bill G0438 (or G0439) + the E/M code with modifier 25. Medicare will pay both in most cases when properly documented.

Important limitation: The AWV is a health risk assessment, not a physical exam. If the patient needs a physical examination during the AWV encounter, document it as part of a separately identifiable problem visit—the AWV itself does not include examination in the traditional sense.

Revenue Opportunity: Maximizing AWV Utilization

AWV has no patient cost-sharing—zero copay, zero deductible. This makes it the most patient-accessible preventive visit you offer. For a primary care practice with 300 Medicare patients:

• AWV reimbursement: G0439 reimburses approximately $145–$160 nationally
• Same-day modifier 25 E/M visit (when applicable): approximately $92–$136 additional
• HCC capture during AWV: significant additional revenue from proper coding of active chronic conditions

Practices that systematically schedule AWVs for all Medicare patients and document them correctly typically capture $40,000–$60,000 in additional annual revenue from this single code set—money that was available but not accessed due to scheduling and documentation gaps.

Krasyn's AWV workflow includes the HRA template, cognitive screening tool integration, and preventive care plan generation—all required elements documented in a single structured workflow. See the AWV workflow.