Preventive & Medicare wellness

G0438 - RVUs & Medicare payment (2026)

Medicare annual wellness visit, initial.

Component	Non-facility	Facility
Work RVU	2.60	2.60
Practice expense RVU	2.45	2.45
Malpractice RVU	0.17	0.17
Total RVUs	5.22	5.22
National payment (CF $33.4009)	$174.35	$174.35
Qualifying APM payment (CF $33.5675)	$175.22	$175.22

How G0438 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for G0438 ranges from $160.06 in Arkansas (AR) to $220.54 in Alaska (AK); calculate G0438 for your locality.

Alaska (AK) $220.54 San Jose-Sunnyvale-Santa Clara (CA) $217.44 San Jose-Sunnyvale-Santa Clara (CA) $216.65 San Francisco-Oakland-Berkeley (CA) $213.08 San Francisco-Oakland-Berkeley (CA) $212.89 Napa (CA) $203.05 Vallejo (CA) $202.77 NYC Suburbs/Long Island (NY) $200.24 National average $174.35 … 97 more localities between … Rest Of Missouri (MO) $162.91 Alabama (AL) $161.66 Mississippi (MS) $161.50 Arkansas (AR) $160.06

Non-facility payment for G0438 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - preventive & medicare wellness

G0402 · welcome to medicare preventive visit (once, first 12 months)
G0439 · medicare annual wellness visit, subsequent

Frequently asked questions

How much does Medicare pay for G0438 in 2026?

The national non-facility payment is $174.35 and the facility payment is $174.35, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for G0438?

The 2026 work RVU for G0438 is 2.60. Total RVUs are 5.22 in the non-facility setting and 5.22 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.