`G0438` Ppps, initial visit

What G0438 is

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.

Medicare payment for G0438 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	2.60	2.45	0.17	5.22	$174.35
Facility (hospital, ASC)	2.60	2.45	0.17	5.22	$174.35

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps G0438 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with G0438? These codes are bundled into it

G0438 is a Column 1 code in 93 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`90791`	Psych diagnostic evaluation	1 - modifier may bypass	Check pair
`90792`	Psych diag eval w/med srvcs	1 - modifier may bypass	Check pair
`90832`	Psytx w pt 30 minutes	1 - modifier may bypass	Check pair
`90833`	Psytx w pt w e/m 30 min	1 - modifier may bypass	Check pair
`90834`	Psytx w pt 45 minutes	1 - modifier may bypass	Check pair
`90836`	Psytx w pt w e/m 45 min	1 - modifier may bypass	Check pair
`90837`	Psytx w pt 60 minutes	1 - modifier may bypass	Check pair
`90838`	Psytx w pt w e/m 60 min	1 - modifier may bypass	Check pair
`90839`	Psytx crisis initial 60 min	1 - modifier may bypass	Check pair
`90845`	Psychoanalysis	1 - modifier may bypass	Check pair
`92002`	Intrm oph exam new patient	1 - modifier may bypass	Check pair
`92004`	Compre oph exam new pt 1/>	1 - modifier may bypass	Check pair
`92012`	Intrm oph exam est patient	1 - modifier may bypass	Check pair
`92014`	Compre oph exam est pt 1/>	1 - modifier may bypass	Check pair
`93793`	Anticoag mgmt pt warfarin	1 - modifier may bypass	Check pair
`95851`	Range of motion measurements	1 - modifier may bypass	Check pair
`95852`	Range of motion measurements	1 - modifier may bypass	Check pair
`96116`	Nubhvl xm phys/qhp 1st hr	1 - modifier may bypass	Check pair
`96127`	Brief emotional/behav assmt	0 - no modifier bypass	Check pair
`96156`	Hlth bhv assmt/reassessment	0 - no modifier bypass	Check pair
`96158`	Hlth bhv ivntj indiv 1st 30	0 - no modifier bypass	Check pair
`96159`	Hlth bhv ivntj indiv ea addl	0 - no modifier bypass	Check pair
`96164`	Hlth bhv ivntj grp 1st 30	0 - no modifier bypass	Check pair
`96165`	Hlth bhv ivntj grp ea addl	0 - no modifier bypass	Check pair
`96167`	Hlth bhv ivntj fam 1st 30	0 - no modifier bypass	Check pair
`96168`	Hlth bhv ivntj fam ea addl	0 - no modifier bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`97161`	Pt eval low complex 20 min	1 - modifier may bypass	Check pair

Showing 30 of 93 column 2 codes. Use the pair checker for any specific combination.

G0438 is bundled into these codes

G0438 appears as a Column 2 code in 2 active edits. Reported with one of these Column 1 codes on the same date of service, G0438 is the code that denies.

Column 1 code	Short description	Modifier indicator
`99483`	Assmt & care pln pt cog imp	1	Check pair
`G0402`	Initial preventive exam	0	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.