HCPCS code G0438 — Ppps, initial visit.
Status: Active.
Effective Jan 1, 2026.
Source: CMS HCPCS Level II.
G0438
ActivePpps, initial visit
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Category:
Procedures
Section:
G-codes: Procedures / Professional Services
Effective:
Jan 1, 2026
Code type:
alphanumeric
OPPS Status:
A
— Paid under a separate fee schedule (not OPPS)
Medicare Part B utilization — 2023
Services billed
18,800,000
Beneficiaries
17,600,000
Medicare paid
$2,857,600,000
Avg per service
$190.00
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of G0438 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 1 |
| Practitioner Services | 1 |
Source: CMS Medicare NCCI Medically Unlikely Edits
Change History
Quarterly changes published by CMS. Revisions may affect the code description, coverage, or rate — review each quarter's changes before submitting claims.
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New Code 2026-Q1Ppps, initial visit