Medicare's Initial Preventive Physical Exam (IPPE)

Medicare Part B beneficiaries are allowed one Medicare Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare Visit, per lifetime and they must have it done within 12 months of the beneficiary's Part B effective date. There are several components that must be provided in an IPPE and below you will find all the necessary components needed if you wish to bill Medicare for an IPPE.

1. Must review medical and social history. This includes: past medical/surgical history (illnesses, hospital stays, surgeries, injuries, allergies and treatments), current prescription medications and OTC supplements, family history (diseases that may be hereditary or put the patient at risk), alcohol, tobacco and illicit drug use, diet and physical activities.

2. Must review patient's risk for depression and other mood disorders. This includes: obtaining current or past experiences with mood disorders.

3. Review patient's functional ability and level of safety. This includes: questions or standardized questionnaires which, at minimum, review activities of daily living, fall risk, hearing impairment and home safety.

4. Exam must include, but not limited to: height, weight, BMI, blood pressure and visual acuity screen.

5. End-of-life planning which is verbal or written information about patient's ability to prepare an advance directive in the case of an injury or illness and whether the provider is willing to follow the patient's wishes.

6. Education, counsel and referrals as needed. Provider is to review previous 5 components and provide education, counseling or referrals as needed. There also needs to be a brief written plan for the patient to obtain a once-in-a-lifetime screening EKG and other preventive services Medicare covers.

Once all the above components are completed, an IPPE can be billed to Medicare. Here are the HCPCS codes used to file IPPE claims:

• G0402 - IPPE; face-to-face visit, services limited to new beneficiary during first 12 months of Medicare enrollment

• G0403 - Electrocardiogram, routine ECG with 12 leads; performed as a screening for the IPPE with interpretation and report

• G0404 - Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the IPPE

• G0405 - Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the IPPE

A preventative ICD-10 code (Z00.00 or Z00.01) is usually billed with these HCPCS codes but you are not required to send a specific ICD-10 and therefore, you may choose any ICD-10 code that is consistent with the patient's exam.

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Source: MLN Education Tool - The ABC's of the Initial Preventive Physical Examination (IPPE)