Question 1

What is HCPCS code G0438?

Accepted Answer

HCPCS code G0438 is "Ppps, initial visit". Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Question 2

What category is G0438 in?

Accepted Answer

G0438 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0438?

Accepted Answer

Use G0438 when billing for ppps, initial visit. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0438 covered by Medicare?

Accepted Answer

Coverage for G0438 (Ppps, initial visit) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0438?

Accepted Answer

Documentation for G0438 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).