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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. G0438
  4. Cost Analysis

How Much Does Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Cost on Medicare?

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

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Average Medicare Payment

$150.96

2023 data

Total Payments (2023)

$66.1M

Services (2023)

435.8K

Price Change (2014–2023)

-8.1%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$164.23$160.1M980.2K—
2015$166.26$165.9M1.0M+1.2%
2016$163.68$159.0M979.4K-1.6%
2017$164.10$156.7M962.1K+0.3%
2018$165.48$149.2M902.3K+0.8%
2019$166.88$142.1M853.6K+0.8%
2020$167.48$99.1M591.6K+0.4%
2021$163.13$92.1M563.7K-2.6%
2022$153.96$73.1M471.8K-5.6%
2023$150.96$66.1M435.8K-1.9%

🗺️ State-by-State Cost Variation

The most expensive state pays 2.0x more than the cheapest for this procedure. AK averages $197.77 vs ME at $98.58.

StateAvg PaymentTotal PaymentsServicesProviders
AK$197.77$154.7K78229
DC$183.71$143.3K78035
NY$171.58$5.6M32.7K1.2K
CT$171.53$421.6K2.5K136
IL$165.56$3.6M21.5K996
MD$165.52$2.3M13.8K503
CA$163.29$7.0M43.0K1.4K
NH$162.36$91.1K56133
WA$160.63$1.2M7.4K331
VI$160.14$33.5K2097
VA$159.66$2.1M12.9K509
MN$158.89$1.6M10.0K491
UT$158.55$398.0K2.5K82
MA$157.84$2.1M13.2K551
TX$156.92$3.5M22.2K962
FL$156.34$4.5M29.0K990
SD$155.75$313.5K2.0K83
NV$154.51$635.4K4.1K153
WY$154.35$144.0K93332
WI$154.12$721.0K4.7K254
HI$153.85$123.8K80530
GA$153.68$1.9M12.1K458
AZ$153.59$1.3M8.3K333
WV$153.44$249.0K1.6K50
DE$152.75$437.5K2.9K92
RI$152.69$160.6K1.1K36
NJ$152.56$2.0M12.8K525
SC$151.69$1.8M12.0K449
NC$149.47$1.9M12.8K613
LA$148.99$1.1M7.3K215
IA$148.38$1.2M7.8K372
ID$148.14$145.2K98041
NM$148.01$192.4K1.3K56
TN$147.65$1.0M6.9K266
IN$147.07$1.9M12.9K552
AL$146.43$422.5K2.9K132
VT$145.91$73.1K50124
MS$144.81$679.9K4.7K181
NE$138.31$1.1M8.0K250
MO$135.77$1.1M8.1K286
CO$134.72$753.9K5.6K249
KY$132.89$728.6K5.5K253
KS$132.76$830.0K6.3K262
PA$131.97$3.2M24.3K1.0K
ND$131.97$218.3K1.7K83
OR$131.34$472.2K3.6K195
OH$130.24$2.2M17.1K755
MI$123.61$999.4K8.1K395
OK$114.15$729.4K6.4K225
MT$112.25$136.4K1.2K64
AR$111.71$587.3K5.3K222

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Maria OrtizFamily PracticeCA$147.7K833$177.31
Amer HomsiInternal MedicineUT$112.9K644$175.28
Florian GegajInternal MedicineFL$97.4K589$165.30
Racquel VolkowitzPhysician AssistantNY$94.5K693$136.39
Stephen LutherInternal MedicineSC$83.8K529$158.42
Christina PaddonNurse PractitionerNY$73.4K546$134.49
Rodney SwensonFamily PracticeCA$73.1K437$167.17
Yosef SeewaldPhysician AssistantNY$71.3K515$138.48
Alex BellidoInternal MedicineFL$64.1K397$161.51
Richard CooleyInternal MedicineLA$63.3K409$154.87
Catherine RinneNurse PractitionerOH$61.9K455$136.14
Hermilito VillarGeneral PracticeCA$61.1K345$177.14
Abdul KhanNephrologyCA$61.1K326$187.31
Sharon MorrisNurse PractitionerIL$61.1K411$148.57
Gabriella DollarNurse PractitionerFL$60.7K442$137.29
Alkesh AminInternal MedicineTX$59.3K364$162.93
Marion KowalewskiInternal MedicineMD$58.0K335$173.15
Cassandra FoxNurse PractitionerKY$57.9K426$135.86
Raquel BarbaNurse PractitionerOH$57.3K410$139.68
Ericka HarmonNurse PractitionerGA$53.1K377$140.97

🤔 Is Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Overpriced?

Based on the data, CPT G0438 shows a 2.0x variation in pricing across states — moderate variation by Medicare standards.

Costs have decreased 8.1% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.

This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.