Can you bill an office visit on the same day as an annual wellness visit?

Yes. Medicare pays for an office visit on the same day as an annual wellness visit (AWV) when the doctor also evaluates and manages a problem, and that work is significant, separately identifiable and medically necessary. Bill the office visit code with modifier 25 alongside the wellness visit code.

The wellness visit is G0438 for a patient's first one and G0439 for every one after, and Medicare pays for one every 12 months. CMS says to report the extra office visit as 99202 to 99205 or 99211 to 99215, with modifier 25 on that code. The wellness visit code never gets the modifier.

What does the wellness visit already cover?

The AWV is a planning visit. The doctor goes over the patient's health risk assessment, medicines, ability to manage daily life, memory, and the screenings she's due for, then writes a prevention plan. Medicare doesn't treat it as a physical exam.

Problems come up during all of that. A patient mentions a sore knee on her risk assessment, or her medication review shows a blood pressure pill. Noticing a problem, or seeing it on a list, is part of the wellness visit. The office visit starts when the doctor works on the problem: examines it, sorts out the cause, orders a test, changes treatment.

The AMA's definition of a problem "addressed" draws the same line. A problem counts when it's evaluated or treated at the visit. A note that another clinician is managing it, with no assessment of your own, doesn't count.

What does a note that supports both look like?

Here are two versions of the same appointment. A 72-year-old is in for her yearly wellness visit (G0439). On her risk assessment she checks "joint pain."

Version A. During the visit she says her right knee has hurt for three weeks, worse on stairs, with no injury. The doctor examines the knee, reviews her urgent care note from last week, orders a right knee X-ray, and recommends acetaminophen and a home exercise sheet. The note has its own short section for the knee: history, exam, assessment, plan.

Version B. The risk assessment and the review of her daily activities note "right knee pain, followed by orthopedics, no change." Nobody examines the knee or changes anything.

	Version A	Version B
Line 1	G0439, pointed to the diagnosis your practice uses for the wellness visit (CMS doesn't require a specific one)	G0439, same
Line 2	99213 with modifier 25, pointed to M25.561, pain in right knee	None
Why	The knee was evaluated and managed, separately from the wellness work.	The knee was noted as part of the wellness review and handled by another clinician.

The level in Version A comes from the knee work alone, using medical decision making (MDM). Three weeks of knee pain with no injury is an acute, uncomplicated problem, which is low. Reviewing the urgent care note and ordering the X-ray are two data elements, which is limited. Low problems plus limited data support a 99213. If the doctor had found something that needed a prescription change, the level could be higher; 99213 vs 99214 shows where that line sits.

Version B is where practices get into trouble. Billing a 99213 there charges for a problem nobody worked on, and that's the pattern auditors look for. Billing only G0439 is right.

One more detail in Version A. The note says right knee, so the code is M25.561. M25.569, knee pain with no side given, is a common miss when the code is picked from a short list, and some insurance companies deny lines for it. Payers now check for a missing side automatically.

What will the patient owe?

This is the part patients notice. Medicare says the wellness visit costs the patient nothing when the provider accepts assignment, and the Part B deductible doesn't apply. For other services during the same visit, Medicare says she may owe coinsurance, and the Part B deductible may apply.

In Version A, the wellness visit is free to her and the knee visit isn't. At Medicare's 2026 national rate, before local adjustment, a 99213 is $95.19. If she has met her deductible, her usual 20% share is about $19. If she hasn't, she may owe more.

A patient who was told the wellness visit is free and then gets a bill will call your office. Tell her at checkout that the knee was a separate visit and her usual share applies to that part. You can also tell patients when they book that a new problem handled during the wellness visit is billed as its own visit.

For a commercial plan's preventive visit, check that plan's rules on same-day sick visits and cost sharing. Medicare's rules don't carry over.

What should you check before the claim goes out?

1. Confirm the wellness visit is due: G0438 for the first, G0439 after that, once in 12 months.
2. Find the problem the doctor evaluated and managed. A separate section in the note makes this easy for the biller.
3. Level the office visit on that problem's work alone.
4. Put modifier 25 on the office visit code and point it to the problem's diagnosis, with the side if the code has one.
5. Let the patient know her share applies to the office visit.

The same separate-work test applies to a same-day minor procedure.

Cortex Lens reads each note in Practice Fusion before it's signed. It flags a code that's missing a left or right, like M25.569 when the note says right knee, and shows the visit level the note's medical decision making supports, 99212 to 99215, up or down. A person makes every change in the chart.

Sources: CMS, Annual Wellness Visit, AWV coding, diagnosis and billing, page last modified April 9, 2026, checked November 5, 2026: modifier 25 on the listed office visit codes, no required AWV diagnosis code, G0438 versus G0439 and the 12-month limit. Patient costs: Medicare.gov, Yearly "Wellness" visits, checked November 5, 2026. Problem and data definitions: AMA, 2023 CPT E/M Descriptors and Guidelines, pages 8, 9, 14 and 15. 2026 national payment amount (2.85 total RVUs times the $33.4009 conversion factor): CMS, PFS Relative Value File RVU26A.