Cost analysis for CPT G0438 — Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Average Medicare Payment
$150.96
2023 data
Total Payments (2023)
$66.1M
Services (2023)
435.8K
Price Change (2014–2023)
-8.1%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $164.23 | $160.1M | 980.2K | — |
| 2015 | $166.26 | $165.9M | 1.0M | +1.2% |
| 2016 | $163.68 | $159.0M | 979.4K | -1.6% |
| 2017 | $164.10 | $156.7M | 962.1K | +0.3% |
| 2018 | $165.48 | $149.2M | 902.3K | +0.8% |
| 2019 | $166.88 | $142.1M | 853.6K | +0.8% |
| 2020 | $167.48 | $99.1M | 591.6K | +0.4% |
| 2021 | $163.13 | $92.1M | 563.7K | -2.6% |
| 2022 | $153.96 | $73.1M | 471.8K | -5.6% |
| 2023 | $150.96 | $66.1M | 435.8K | -1.9% |
The most expensive state pays 2.0x more than the cheapest for this procedure. AK averages $197.77 vs ME at $98.58.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $197.77 | $154.7K | 782 | 29 |
| DC | $183.71 | $143.3K | 780 | 35 |
| NY | $171.58 | $5.6M | 32.7K | 1.2K |
| CT | $171.53 | $421.6K | 2.5K | 136 |
| IL | $165.56 | $3.6M | 21.5K | 996 |
| MD | $165.52 | $2.3M | 13.8K | 503 |
| CA | $163.29 | $7.0M | 43.0K | 1.4K |
| NH | $162.36 | $91.1K | 561 | 33 |
| WA | $160.63 | $1.2M | 7.4K | 331 |
| VI | $160.14 | $33.5K | 209 | 7 |
| VA | $159.66 | $2.1M | 12.9K | 509 |
| MN | $158.89 | $1.6M | 10.0K | 491 |
| UT | $158.55 | $398.0K | 2.5K | 82 |
| MA | $157.84 | $2.1M | 13.2K | 551 |
| TX | $156.92 | $3.5M | 22.2K | 962 |
| FL | $156.34 | $4.5M | 29.0K | 990 |
| SD | $155.75 | $313.5K | 2.0K | 83 |
| NV | $154.51 | $635.4K | 4.1K | 153 |
| WY | $154.35 | $144.0K | 933 | 32 |
| WI | $154.12 | $721.0K | 4.7K | 254 |
| HI | $153.85 | $123.8K | 805 | 30 |
| GA | $153.68 | $1.9M | 12.1K | 458 |
| AZ | $153.59 | $1.3M | 8.3K | 333 |
| WV | $153.44 | $249.0K | 1.6K | 50 |
| DE | $152.75 | $437.5K | 2.9K | 92 |
| RI | $152.69 | $160.6K | 1.1K | 36 |
| NJ | $152.56 | $2.0M | 12.8K | 525 |
| SC | $151.69 | $1.8M | 12.0K | 449 |
| NC | $149.47 | $1.9M | 12.8K | 613 |
| LA | $148.99 | $1.1M | 7.3K | 215 |
| IA | $148.38 | $1.2M | 7.8K | 372 |
| ID | $148.14 | $145.2K | 980 | 41 |
| NM | $148.01 | $192.4K | 1.3K | 56 |
| TN | $147.65 | $1.0M | 6.9K | 266 |
| IN | $147.07 | $1.9M | 12.9K | 552 |
| AL | $146.43 | $422.5K | 2.9K | 132 |
| VT | $145.91 | $73.1K | 501 | 24 |
| MS | $144.81 | $679.9K | 4.7K | 181 |
| NE | $138.31 | $1.1M | 8.0K | 250 |
| MO | $135.77 | $1.1M | 8.1K | 286 |
| CO | $134.72 | $753.9K | 5.6K | 249 |
| KY | $132.89 | $728.6K | 5.5K | 253 |
| KS | $132.76 | $830.0K | 6.3K | 262 |
| PA | $131.97 | $3.2M | 24.3K | 1.0K |
| ND | $131.97 | $218.3K | 1.7K | 83 |
| OR | $131.34 | $472.2K | 3.6K | 195 |
| OH | $130.24 | $2.2M | 17.1K | 755 |
| MI | $123.61 | $999.4K | 8.1K | 395 |
| OK | $114.15 | $729.4K | 6.4K | 225 |
| MT | $112.25 | $136.4K | 1.2K | 64 |
| AR | $111.71 | $587.3K | 5.3K | 222 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Maria Ortiz | Family Practice | CA | $147.7K | 833 | $177.31 |
| Amer Homsi | Internal Medicine | UT | $112.9K | 644 | $175.28 |
| Florian Gegaj | Internal Medicine | FL | $97.4K | 589 | $165.30 |
| Racquel Volkowitz | Physician Assistant | NY | $94.5K | 693 | $136.39 |
| Stephen Luther | Internal Medicine | SC | $83.8K | 529 | $158.42 |
| Christina Paddon | Nurse Practitioner | NY | $73.4K | 546 | $134.49 |
| Rodney Swenson | Family Practice | CA | $73.1K | 437 | $167.17 |
| Yosef Seewald | Physician Assistant | NY | $71.3K | 515 | $138.48 |
| Alex Bellido | Internal Medicine | FL | $64.1K | 397 | $161.51 |
| Richard Cooley | Internal Medicine | LA | $63.3K | 409 | $154.87 |
| Catherine Rinne | Nurse Practitioner | OH | $61.9K | 455 | $136.14 |
| Hermilito Villar | General Practice | CA | $61.1K | 345 | $177.14 |
| Abdul Khan | Nephrology | CA | $61.1K | 326 | $187.31 |
| Sharon Morris | Nurse Practitioner | IL | $61.1K | 411 | $148.57 |
| Gabriella Dollar | Nurse Practitioner | FL | $60.7K | 442 | $137.29 |
| Alkesh Amin | Internal Medicine | TX | $59.3K | 364 | $162.93 |
| Marion Kowalewski | Internal Medicine | MD | $58.0K | 335 | $173.15 |
| Cassandra Fox | Nurse Practitioner | KY | $57.9K | 426 | $135.86 |
| Raquel Barba | Nurse Practitioner | OH | $57.3K | 410 | $139.68 |
| Ericka Harmon | Nurse Practitioner | GA | $53.1K | 377 | $140.97 |
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.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.