#2311 of 11K

G0438

Annual wellness visit, first visit

Annual wellness visit, first visit is the #2,311 most-billed Medicaid procedure code, with $6.8M in payments across 263K claims from 2018–2024. The national median cost per claim is $19.28. Costs vary widely — the 90th percentile is $127.53 per claim, 6.6× the median.

Total Paid

$6.8M

0.00% of all spending

Total Claims

263K

Providers

Avg Cost/Claim

$26

National Cost Distribution

How much do providers bill per claim for G0438? Based on 519 providers billing this code nationally.

Median

$19.28

Average

$45.31

Std Dev

$52.07

Max

$275.00

Percentile Distribution (Cost per Claim)

p10

$0.88

p25

$4.40

Median

$19.28

p75

$81.94

p90

$127.53

p95

$146.15

p99

$200.21

50% of providers bill between $4.40 and $81.94 per claim for this code.

90% bill between $0.88 and $127.53.

Top 1% bill above $200.21.

About This Procedure

HCPCS code G0438 (Annual wellness visit, first visit) was billed by 1K providers across 263K claims, totaling $6.8M in Medicaid payments from 2018–2024. This code was used for 246K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$19.28

Providers Billing

519

National Spending

$6.8M

Avg/Median Ratio

2.35×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for G0438

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1003849621	$537K	$165.74	8.6× median	Top 10%
2	1982095543	$390K	$61.59	3.2× median	Above Median
3	1376635045	$294K	$94.08	4.9× median	Above 75th
4	1205265279	$272K	$86.53	4.5× median	Above 75th
5	1356839872	$229K	$195.15	10.1× median	Top 10%
6	1396749941	$227K	$84.36	4.4× median	Above 75th
7	1558445403	$222K	$129.22	6.7× median	Top 10%
8	1700886322	$212K	$199.18	10.3× median	Top 10%
9	1245315456	$211K	$89.33	4.6× median	Above 75th
10	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$193K	$123.49	6.4× median	Above 75th
11	Group Health Plan, Inc. Minneapolis, MN · Clinic/Center, Multi-Specialty	$192K	$44.16	2.3× median	Above Median
12	1750766762	$186K	$159.99	8.3× median	Top 10%
13	1730184110	$174K	$134.73	7.0× median	Top 10%
14	1982840922	$141K	$126.78	6.6× median	Above 75th
15	Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology	$135K	$48.78	2.5× median	Above Median
16	1366618019	$120K	$99.10	5.1× median	Above 75th
17	1326434291	$119K	$95.73	5.0× median	Above 75th
18	1083759641	$118K	$102.41	5.3× median	Above 75th
19	1750803631	$118K	$83.27	4.3× median	Above 75th
20	1558394312	$110K	$145.72	7.6× median	Top 10%

Showing top 20 of 1K providers billing this code

Related Procedures

G0447$31.8M G0439Annual wellness visit, subsequent visit$31.5M G0444Annual depression screening, fifteen minutes$14.5M G0442$12.0M G0446$2.0M

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