Preventive Visit wRVUs: What Annual Exams Actually Generate in 2026

Annual physicals are not low-wRVU visits for adult patients

A common assumption among physicians entering their first production-based contract is that annual physical exams generate modest wRVU credit — less than a typical problem visit. For pediatric patients and routine child wellness checks, this may be true. But for adult patients, particularly those aged 40 and older, the preventive medicine codes generate wRVU values that are comparable to moderate-complexity established visits. Knowing the actual numbers matters when you are estimating how close your preventive visit volume brings you to your annual threshold.

CMS assigns wRVU values to preventive medicine visits through the same process used for all physician services: a relative weighting that reflects the typical physician work, time, and mental effort involved. Adult preventive visits include a comprehensive history, a multi-system review, age- and sex-appropriate screening decisions, and counseling — work that CMS values similarly to a moderate established visit. The wRVU credit your employer records is based on those CMS-set values, not on what any particular payer reimburses for the visit.

The 2026 wRVU values for preventive medicine codes

Preventive medicine visit codes come in two families: new patient (99381–99387) and established patient (99391–99397), each broken out by age group. The values below are from the 2026 CMS Physician Fee Schedule.

Established patient preventive visits (99391–99397)

New patient preventive visits (99381–99387)

These values are sourced from the CMS 2026 Physician Fee Schedule relative value file. They represent the work RVU component, which is what physician employment contracts use to measure production — not the total RVU, which also includes practice expense and malpractice components.

How preventive visits compare to standard office visit codes

The practical comparison that matters most is between the preventive codes and the established patient E/M codes most physicians bill every day.

For an established adult patient aged 40–64, the annual physical (99396, 1.90 wRVU) produces essentially the same wRVU credit as a moderate-complexity problem visit (99214, 1.92 wRVU). For patients 65 and older, 99397 at 2.00 wRVU slightly exceeds 99214. A physician who assumed their annual physicals were contributing 1.30 wRVU each — the level 3 problem visit value — has been underestimating their preventive contribution by roughly 45% for their adult panel.

For new adult patients, the numbers are higher still. A new patient aged 40–64 preventive visit (99386, 2.33 wRVU) sits between a level 4 and level 5 established visit. The first annual physical with a new provider generates meaningfully more wRVU credit than any subsequent year's visit with the same patient.

When a same-day problem visit adds more wRVU credit

When a physician addresses a genuinely separate medical problem during the same encounter as the annual physical, both the preventive visit and a problem-focused E/M service can be billed for that day. The E/M code receives modifier 25, which signals that it represents a significant, separately identifiable service beyond the scope of the preventive visit itself.

The documentation bar is real: the problem-focused work must be medically necessary, documented in its own right, and must reflect physician effort that goes beyond what the preventive exam already captured. If a 52-year-old patient comes in for a physical and also has an acute complaint — a new rash, shoulder pain that needs assessment, an uncontrolled blood pressure reading that warrants a management decision — billing both the preventive code and a separate E/M code with modifier 25 is legitimate when the note supports it.

As an example: a physician bills 99396 (1.90 wRVU) for the preventive visit and 99213 with modifier 25 (1.30 wRVU) for the separately evaluated problem. The combined wRVU credit for that encounter is 3.20 — more than a level 5 established visit (99215, 2.80 wRVU). The same encounter with a 65-year-old patient using 99397 + 99214-25 would yield 2.00 + 1.92 = 3.92 wRVUs.

These are illustrations of the additive wRVU potential, not prescriptions for how to code. The documentation has to drive the code selection, not the other way around. Payers may also reduce payment on the modifier-25 service — some pay it at a reduced percentage — but that affects revenue, not necessarily the wRVU credit your employer records toward your production threshold (see the next section).

How wRVU credit works in employment contracts for these visits

In most physician employment arrangements, production is measured in terms of work RVUs credited per code billed, using CMS Physician Fee Schedule values regardless of what any specific payer reimburses. This means that even if a commercial insurer pays the modifier-25 E/M at a reduced rate, your employer's wRVU count for your production typically reflects the full CMS wRVU value for each code you submitted.

That said, employment contracts vary. Some define production based on billed charges, some on allowed amounts, some on paid claims, and some on a custom fee schedule that may not match CMS values exactly. A contract that counts only "paid" claims would treat a denied modifier-25 service differently than one that counts "billed" or "submitted" services. It is worth reading how your compensation document defines the production metric before assuming a particular billing scenario will translate directly into threshold progress.

Preventive medicine codes themselves are generally straightforward — they appear on the CMS fee schedule with their own wRVU values and are credited the same way as any other office visit code. If your employer uses a standard wRVU-based production model, your 99396 visits are worth 1.90 wRVUs each, the same as the CMS value.

Medicare Annual Wellness Visits: a separate set of codes

Traditional Medicare does not cover the routine annual physical under Part B. Instead, it covers a distinct service called the Annual Wellness Visit (AWV), which follows a structured protocol and is billed using HCPCS G codes rather than the CPT 99381–99397 family. The initial AWV (G0438) and the subsequent AWV (G0439) have their own wRVU values on the CMS fee schedule. Per 2026 CMS Physician Fee Schedule data, the initial AWV (G0438) carries a work RVU of 2.60 — equivalent to a level 4 new patient office visit.

For primary care physicians with a predominantly Medicare patient panel, AWV visits can be a meaningful portion of annual production. Most employer compensation models count G code wRVUs the same way as CPT code wRVUs, since they appear on the same fee schedule. However, if your contract specifies CPT codes only, or uses a custom internal code list, it is worth confirming that the AWV G codes are included. Use the free RVU calculator to look up the current wRVU value for G0438 and G0439 and confirm against your employer's listed code values.

What this means for primary care production planning

For a primary care physician with a panel heavily weighted toward adult established patients, preventive visits contribute a substantial share of annual wRVU production. Consider a physician whose schedule includes 800 annual physicals per year — a reasonable figure for a full-time primary care physician with an established adult panel. If those visits average 1.85 wRVU each (a mix of 99395, 99396, and 99397 depending on patient age), preventive visits alone account for approximately 1,480 wRVUs before a single problem visit is counted. At a threshold of 4,500 wRVUs, preventive visits cover about 33% of the total.

The implication for contract review: if your employer gives you meaningful access to preventive visit scheduling — adequate annual physical slots, reasonable panel size, continuity of care — that scheduling capacity directly translates into production. Conversely, if scheduling policies limit your annual exam slots or reassign your established patients, you are losing wRVU credit that is otherwise straightforward to generate. This is a practical reason to ask, in any employment negotiation, whether annual physical access is controlled by you or by the practice.