Medicare Informatics - Medicare Informatics & Data Analysis in Cloud

Initial Preventive Physical Examination (IPPE)

Medicare covers a one-time preventive visit within the first 12 months that you have Medicare Part B (Medical Insurance). This visit is called the “Welcome to Medicare” preventive visit. The visit is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy.

HCPCS/CPT Codes

G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

G0405 – Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

G0468 – Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

ICD-10-CM (ICD-9-CM) Codes

No specific diagnosis code

Contact local Medicare Administrative Contractor (MAC) for guidance

Who Is Covered

All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period

Frequency

Once in a lifetime

Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

Beneficiary Pays

G0402:

Copayment/coinsurance WAIVED
Deductible WAIVED

G0403, G0404, and G0405:

Copayment/coinsurance appliesli>
Deductible applies

G0468:

•AWV or IPPE must be provided with a standard bundle of services available to all beneficiaries to use this code; refer to pages 2, 5, and 6 of the Frequently Asked Questions on the Medicare FQHC PPS fact sheet for more informationli>
Copayment/coinsurance appliesli>
Deductible applies

Frequently Asked Questions (FAQs)

What happens during the visit?

During the visit, your doctor will:

Record your medical and social history (like alcohol or tobacco use, your diet, and your activity level).
Check your height, weight, and blood pressure.
Calculate your body mass index (BMI).
Give you a simple vision test.
Review your potential risk for depression and your level of safety.
Offer to talk with you about creating advance directives. Advance directives are legal documents that allow you to put in writing what kind of health care you would want if you were too ill to speak for yourself.

Depending on your general health and medical history, your doctor will give you advice on education, and counseling to help you prevent disease, improve your health, and stay well. Your doctor will also give you a written plan (like a checklist) letting you know what screenings, shots, and other preventive services you need.

What should I bring to the visit?

When you go to your “Welcome to Medicare” preventive visit, bring these items:

Your medical records, including immunization records (if you’re seeing a new doctor). Call your old doctor to get copies of your medical records.
Your family health history. Try to learn as much as you can about your family’s health history before your appointment. Any information you can give your doctor can help determine if you’re at risk for certain diseases.
A list of prescription and over-the-counter drugs that you currently take, how often you take them, and why.

Can a Home Health provider conduct an IPPE in the patient's home?

No, a Home Health Agency cannot provide the IPPE. This service is not billable on institutional types of bill 32x or 34x.

Is the IPPE the same as a beneficiary’s yearly physical?

No. The IPPE is not a “routine physical checkup” that some seniors may get every year or so from their physician or other qualified non-physician practitioner. The IPPE is an introduction to Medicare and covered benefits and focuses on health promotion and disease prevention and detection to help beneficiaries stay well. Medicare does not cover routine physical examinations.

Are clinical laboratory tests part of the IPPE?

No. The IPPE does not include any clinical laboratory tests, but you may make referrals for such tests as part of the IPPE, if appropriate.

Do deductible or coinsurance/copayment apply for the IPPE?

No. Medicare waives both the coinsurance/copayment and the Medicare Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening ECG (HCPCS codes G0403, G0404, or G0405).

If a beneficiary enrolled in Medicare in 2014, can he or she have the IPPE in 2015 if it was not performed in 2014?

A beneficiary who has not yet had an IPPE and whose initial enrollment in Medicare Part B began in 2014 is eligible for an IPPE in 2015 as long as it is done within 12 months of the beneficiary’s first Medicare Part B enrollment effective date.