Does Medicare require a modifier for G0136 billed with an AWV?

Yes. When G0136 is billed on the same date of service as the AWV, append modifier 33 (Preventive Services) so the patient's copayment and deductible are waived for that charge.

Can Nurse Practitioners Bill G0136 With the Annual Wellness Visit? How Much Extra You Can Make | NPWise

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Can Nurse Practitioners Bill G0136 With the Annual Wellness Visit? Here's How Much Extra You Can Make

Q: Can nurse practitioners bill G0136 with the Annual Wellness Visit?

Yes. G0136 is a separately payable HCPCS code that NP-owned practices can report in addition to the AWV codes G0438 or G0439, as long as documentation supports the standardized, evidence-based physical activity and nutrition assessment described by the code.

Q: How much do nurse practitioners get paid for billing G0136?

Nationally, before geographic adjustment, G0136 pays roughly $19 at the full physician rate in a non-facility (office) setting. Because Medicare pays nurse practitioners 85 percent of the physician fee schedule rate when billing under their own NPI, that works out to approximately $16 per patient for NPs, with the exact amount varying by locality.

Q: What is HCPCS code G0136?

As of the 2026 code descriptor, G0136 covers the administration of a standardized, evidence-based assessment of physical activity and nutrition, taking 5 to 15 minutes, billed no more than once every 6 months per patient.

Most NPs run this exact assessment at nearly every AWV — and never bill for it separately. G0136 turns a few minutes of work you're already doing into real, extra revenue. Here's the actual dollar range, and exactly what CMS wants documented.

📅 July 5, 2026 🩺 Billing ⏱ 7 min read

G0136 billing with the Annual Wellness Visit for nurse practitioners

If you're an NP running Medicare Annual Wellness Visits, there's a good chance you're doing reimbursable clinical work and not billing for it. HCPCS code G0136 is a separately payable add-on to the AWV, and CMS actually strengthened the code in the 2026 Medicare Physician Fee Schedule after almost eliminating it. It's still one of the most under-billed codes in independent practice — and unlike a lot of "extra revenue" advice, this one comes straight from CMS's own rules.

What Is G0136, Exactly?

As of the 2026 code descriptor, G0136 covers the administration of a standardized, evidence-based assessment of physical activity and nutrition, 5–15 minutes, not more often than every 6 months. This replaced the code's original, broader social determinants of health (SDOH) framing from when it was first created in 2024.

Worth knowing: CMS actually proposed deleting G0136 entirely in the CY 2026 proposed rule, arguing the work was already captured in E/M visits. After pushback from practitioners, the final rule kept the code — narrowed to physical activity and nutrition — and it remains on the Medicare Telehealth Services list.

How Much Extra Can You Actually Make?

Here's the number most articles skip. Nationally, before geographic adjustment, G0136 carries a non-facility (office) total RVU of about 0.57. Multiplied by the 2026 conversion factor (roughly $33.40–$33.57), that's approximately $19 at the full physician rate.

Medicare pays nurse practitioners 85% of the physician fee schedule rate when billing under their own NPI — that's the standard NP payment rule across nearly all professional services, not just this one. Applied to G0136, that puts the real NP reimbursement at roughly $16 per patient in the office setting (facility settings, like a hospital-based clinic, pay meaningfully less — closer to $5).

What that looks like across a year

$1,600 – $2,880+estimated extra annual revenue for a solo NP practice adding G0136 to 100–180 eligible AWVs a year

Scale that across a multi-provider practice, or a full Medicare panel, and the number climbs fast — for an assessment your staff may already be doing informally and simply not billing separately.

These are national averages before your locality's GPCI adjustment. Your exact rate will differ slightly by state and MAC — the CMS Physician Fee Schedule Look-Up Tool will give you your precise, locality-adjusted number.

How G0136 Fits With the Annual Wellness Visit

The AWV itself is billed using G0438 (first AWV) or G0439 (subsequent AWV). G0136 is an optional add-on to that same visit — billed separately, on top of the AWV code, not instead of it.

Code	What it covers
G0438	Initial Annual Wellness Visit
G0439	Subsequent Annual Wellness Visit
G0136	Standardized physical activity & nutrition assessment, 5–15 min, every 6 months max — billed in addition to G0438/G0439

The Modifier That Makes or Breaks This Claim

When G0136 is reported the same date as the AWV, append modifier 33 (Preventive Services). That waives the patient's copay and deductible for the charge. If G0136 is billed the same day as a regular E/M visit instead of the AWV, cost-sharing does apply — worth telling the patient ahead of time.

Documentation Requirements: What CMS Actually Wants to See

This is where most practices lose the reimbursement — not because the clinical work wasn't done, but because it wasn't documented as its own billable line item. To support G0136, your note should include:

The name or type of standardized, evidence-based tool used for the physical activity and nutrition assessment.
Time spent — documented as a specific number of minutes between 5 and 15, not just "assessment performed."
The findings of the assessment, in enough detail to show clinical relevance.
The qualifying visit it's tied to — the AWV (G0438/G0439), an E/M visit, or for behavioral health providers, a psychiatric diagnostic evaluation (90791) or Health Behavior Assessment and Intervention codes (96156, 96158, 96159, 96164, 96165, 96167, 96168).
Frequency check — confirm it hasn't already been billed for this patient in the past 6 months.
A signed, dated note from the billing provider, separate and identifiable from the AWV documentation itself.

Who's Eligible for the AWV in the First Place

The AWV is available to Medicare beneficiaries who are not within 12 months of their first Medicare Part B effective date, and who have not already had an Initial Preventive Physical Examination or an AWV in the past 12 months. If your patient qualifies for the AWV, G0136 can be layered on top when the assessment is clinically appropriate and properly documented.

Where NP Practices Actually Lose This Revenue

In our experience reviewing charts for independent practices, it's almost never a clinical gap — providers are already asking about activity and nutrition. It's a documentation and coding gap: the assessment happens, but it's buried inside the AWV note instead of being coded and billed as its own line item with the right modifier attached.

Frequently Asked Questions

Can nurse practitioners bill G0136 with the Annual Wellness Visit?

Yes. NP-owned practices can report G0136 in addition to G0438 or G0439 when the standardized physical activity and nutrition assessment is performed and documented per CMS guidelines.

How much do nurse practitioners get paid for billing G0136?

Roughly $16 per patient in the office setting, based on the national non-facility rate and the standard 85% NP payment differential — before your locality's geographic adjustment.

Is G0136 billed instead of the AWV, or in addition to it?

In addition to it. G0136 is a separately payable add-on code — it does not replace G0438 or G0439.

How often can G0136 be billed per patient?

Not more often than every 6 months, per the revised 2026 code descriptor.

What modifier is needed for G0136 with an AWV?

Modifier 33 (Preventive Services), appended when G0136 is billed the same date as the AWV, to waive the patient's cost-sharing for that service.

This Is Exactly the Kind of Revenue NPWise Catches

We built our billing service specifically for NP-owned and NP-led practices — codes like G0136 are a small example of a bigger pattern: reimbursable work that's happening in the room and not making it onto the claim.