G0438 — Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

What the market charges

Across 899 negotiated rates, the middle 80% fall between $115 and $389, with a median of $182.

What Medicare pays

Medicare allowed an average of $151 for this code, across 410,324 services billed by 15,848 providers. At the median, the market charges 1.2 times what Medicare pays for this code.

Where this is billed, and what it costs there

The states billing G0438 most, by Medicare service volume, each compared against the national average of $151. Each links to the providers Mishe lists there.

  • California — 1,358 providers billed it, Medicare allowed $165 — 9% above the national average
  • Florida — 895 providers billed it, Medicare allowed $153 — 1% above the national average
  • New York — 1,034 providers billed it, Medicare allowed $169 — 12% above the national average
  • Pennsylvania — 983 providers billed it, Medicare allowed $141 — 7% below the national average
  • Texas — 843 providers billed it, Medicare allowed $155 — 3% above the national average
  • Illinois — 798 providers billed it, Medicare allowed $164 — 9% above the national average
  • Massachusetts — 655 providers billed it, Medicare allowed $159 — 5% above the national average
  • Ohio — 676 providers billed it, Medicare allowed $126 — 17% below the national average

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

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