Medicare AdvantageReimbursementHigh impact
Medicare annual wellness visit (AWV) reimbursement rate change 2022
UPMC Health Plan·Reimbursement
Effective date
Jan 1, 2022
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is increasing reimbursement rates for Medicare annual wellness visits effective January 1, 2022. G0438 will be reimbursed at $200 and G0439 at $175. Billing teams must ensure visits are coded as wellness-only with proper CMS-compliant documentation to avoid claim denials and audits.
Action Required
By December 31, 2021: Billing team must update reimbursement rates in billing software for UPMC Health Plan Medicare patients: G0438 to $200 and G0439 to $175. Coordinate with providers and clinical staff to ensure AWV claims are coded as wellness-only (G0438 or G0439 exclusively) with complete CMS-defined clinical documentation in medical records. Add compliance checklist to encounter templates to prevent bundling with other visit types. Prepare for UPMC Health Plan audits of submitted claims. Document all changes in billing system audit logs.