Key Takeaways on the IPPE Medicare Wellness Exam
- IPPE Medicare (aka Welcome to Medicare) is a one-time preventive visit available within the first 12 months of Medicare Part B enrollment.
- The IPPE visit focuses on prevention, health education, and a written prevention plan not a routine annual physical.
- Medicare covers the IPPE at 100% (no deductible or coinsurance for G0402); ECG/EKG screenings have different cost-sharing rules.
- Rural clinics can use the IPPE to improve early detection, build care plans, and engage patients before conditions worsen.
What Is the IPPE Medicare Exam?
The Initial Preventive Physical Examination (IPPE), or IPP Medicare exam, is a one-time, Medicare-covered, face-to-face preventive visit that happens in the first 12 months of a patient’s Medicare Part B enrollment. It includes a review of medical and social history, basic measurements (for example, BMI, blood pressure), prevention counseling and education, and a personalized written plan for screenings and vaccinations.
Also called the Welcome to Medicare Preventive Visit, the IPPE is not an annual physical. It’s a one-time visit that emphasizes health promotion, disease prevention, and early detection. It’s a time for providers to improve a patient’s quality of care, create care coordination plans, and uncover their health conditions and concerns. It’s also an opportunity for the provider and patient to discuss advance directives and document future healthcare wishes, if the patient agrees.
Who Can Perform an IPPE Medicare Exam?
- Physician — a doctor of medicine or osteopathy
- Qualified non-physician practitioner (NPP) — a physician assistant /associate (PA), nurse practitioner (NP), or certified clinical nurse specialist (CNS)
What Does Medicare Cover for the Exam?
- The exam (G0402) is covered at 100% (no coinsurance/copay) once per lifetime within 12 months of first Medicare Part B enrollment
Why the IPPE Matters for Rural Health Clinics
Rural communities have higher rates of chronic diseases and illnesses. But rural patients often have less access to care and healthcare education. Many patients wait a long time to treat an illness or don’t come into their nearest rural health clinic (RHC) until they’re already sick.
As a result, the IPPE exam is crucial to improving patient care and quality of life. The IPPE is an opportunity to create change in the community through preventative medicine. And the patient engagement and education component to the exam can be done at the same time as other visits.
What’s Involved in the IPPE Medicare Exam
The IPPE exam is a one time event. Medicare pays for one IPPE per patient per lifetime. The visit must take place no later than the first 12 months after the patient’s initial Medicare Part B eligibility date, typically when they turn 65.
During the visit, a provider might recommend that the patient receive services more frequently than Medicare covers or services Medicare doesn’t cover. If this is the case, providers want to ensure the patient understands they may pay some or all of the cost.
Why Is Azalea Best for Rural and Ambulatory Clinics?
The exam includes nine basic components.
Nine Components of the IPPE Exam
- Review the patient’s medical and social history
- Past medical and surgical history, including illnesses, hospital stays, operations, allergies, injuries, and treatments
- Current medications and supplements, including calcium and vitamins
- Family medical history, including as hereditary conditions that may place them at increased risk
- Diet
- Physical activities
- Alcohol, tobacco, and illegal drug use
- Review patient’s depression risk factors
- Various standardized screening tools designed for this purpose and recognized by national professional medical organizations can be used. Find more information on depression screening on the American Psychological Association’s depression assessment webpage.
- Review the patient’s functional ability and safety level
Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations. Cover, at minimum, these areas:
- Ability to perform activities of daily living (ADLs)
- Fall risk
- Hearing impairment
- Home safety
- Perform a physical exam and document:
- Height
- Weight
- Body mass index (BMI) or waist circumference
- Blood pressure
- Balance
- Gait
- Visual acuity screen
- Other appropriate factors based on medical and social history and current clinical standards
- End-of-life planning if patient agrees
Discuss end-of-life planning in verbal or written format about the patient’s opportunity to create an advanced director if an injury or illness prevents them from making their own health care decisions.
- Review current opioid prescriptions
For a patient with a current opioid prescription:
- Review their potential opioid use disorder (OUD) risk factors
- Evaluate the patient’s pain severity and current treatment plan
- Provide information on non-opioid treatment options. Refer to a specialist, as appropriate. Find more information on pain management in the HHS Pain Management Report.
- Screen for potential substance use disorders (SUDs)
- Review the patient’s potential risk factors for SUDs and, as appropriate, refer them for treatment. Using a screening tool is optional. Find more information on the National Institute on Drug Abuse Screening and Assessment Tools Chart.
- Educate, counsel, and refer based on previous components
- Based on the results of the review and evaluation services in the previous components, administer appropriate education, counseling, and referral
- Educate, counsel, and refer for other preventive services
Give the patient a brief written plan, such as a checklist, for items the patient get get after the visit:
- A once-in-a-lifetime screening electrocardiogram (ECG/EKG), as appropriate
- Appropriate screenings and other preventive services Medicare covers in its yearly/annual wellness visits (AWVs)
After the first visit beneficiaries are eligible for an annual wellness visit (AWV), which updates the prevention plan.
Tip: Practices can use EHR data to identify IPPE-eligible patients and build templates to capture all IPPE elements.
Coding, Diagnosis, and Billing for the IPPE Exam
Accurate coding, diagnosis, and billing are important when submitting a claim for an IPPE for Medicare beneficiaries. Providers want to use the appropriate HCPCS codes for the IPPE and any associated ECG/EKG screening and a diagnosis code consistent with the exam.
IPPE Medicare Exam Codes
There are four main HCPCS codes used to file IPPE and ECG/EKG screening claims and one for FQHCs specifically. All exams will include G0402 and one of G0404, G0404, or G0405 if an ECG is performed.
- G0402 – Initial preventive physical examination; face-to-face visit, services limited to a new beneficiary during the first 12 months of Medicare coverage
- 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; anFQHC visit that includes an IPPE or AWV and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV
Note: Medicare waives the patient’s coinsurance/copayment and the Medicare Part B deductible for the IPPE (HCPCS code G0402). It doesn’t waive them for the screening electrocardiogram (ECG/EKG) (HCPCS codes G0403, G0404, or G0405).
Diagnosis as Part of the IPPE
A diagnosis code must be submitted for an IPPE claim. Medicare doesn’t require that a provider document an IPPE diagnosis code, so any diagnosis code consistent with the patient’s exam can be used.
Billing for an IPPE
Medicare Part B covers an IPPE when performed by a:
- Physician (MD or DO)
- Qualified NPP (CCNS, NP, or PA)
When an IPPE is done along with a separately identifiable and medically necessary evaluation and management (E/M) service, Medicare might cover the E/M service if the additional CPT code (99201–99215) with modifier –25 is reported.
What’s Not Included in the IPPE Medicare Visit
The IPPE visit doesn’t include clinical laboratory tests. Providers though can make referrals for tests as part of the IPPE.
IPPE vs AWV
The IPPE isn’t a routine physical that some Medicare recipients get periodically from their physician or other qualified NPP. The IPPE is a one-time introduction to Medicare and its covered benefits.
Medicare does cover a yearly or annual wellness visit (AWV) that includes a health risk assessment. And even though components of both exams are similar, the AWV is separate from the IPPE. Patients don’t pay the Part B deductible or copay for an AWV.
Medicare Part B Preventive Services
The following services are separate from the IPPE Medicare exam. Provider and patient can discuss them during an IPPE, and a provider can refer a patient for one of these services in the IPPE, but visits for these services are billed separately.
- Advance care planning (ACP) as an optional AWV element
- Alcohol misuse screening and counseling
- Annual wellness visit (AWV)
- Bone mass measurements
- Cardiovascular disease screening tests
- Colorectal cancer screening
- Counseling to prevent tobacco use
- Depression screening
- Diabetes screening
- Diabetes self-management training (DSMT)
- Flu, pneumococcal, & hepatitis B shots and their administration
- Glaucoma screening
- Hepatitis B screening
- Hepatitis C screening
- Human immunodeficiency virus (HIV) screening
- Intensive behavioral therapy (IBT) for cardiovascular disease (CVD)
- IBT for obesity
- Initial preventive physical examination (IPPE)
- Lung cancer screening
- Medical nutrition therapy (MNT)
- Medicare diabetes prevention program (MDPP)
- Prolonged preventive services
- Prostate cancer screening
- Screening for cervical cancer with human papillomavirus (HPV) tests
- Screening for sexually transmitted infections (STIs) & high intensity behavioral counseling (HIBC) to prevent STIs
- Screening mammography
- Screening pap tests
- Screening pelvic examination (includes a clinical breast examination)
- Ultrasound screening for abdominal aortic aneurysm (AAA)
Learn the Medicare Annual Wellness Visit and What’s Involved
Find Patients Eligible for IPPE Medicare Visits
Identifying patients eligible for preventive care, including the IPPE Medicare “Welcome to Medicare” visit, can improve outcomes and reduce downstream costs.
For rural health clinics, FQHCs, and other settings, your EHR can help identify eligible patients by checking:
- Medicare Part B enrollment effective date (within 12 months)
- Patient medical/social history flags and chronic condition risks
- Preventive services due based on age/risk factors
