Initial Preventive Physical Exam or “Welcome to Medicare” Visit

What is an Initial Preventive Physical Exam (IPPE)?

The Centers for Medicare and Medicaid Services (CMS) established the Initial Preventive Physical Exam (IPPE) or the “Welcome to Medicare” visit. An IPPE visit is only conducted once to provide Traditional Medicare patients with information about Medicare and their covered benefits as well as cover health promotion and disease prevention. The IPPE is different than an annual physical exam. IPPEs are provided with no patient cost sharing.

An IPPE is available once per lifetime per patient within the first 12 months of their Part B coverage. After the first IPPE visit, patients are eligible for an AWV every 12 months. The IPPE includes:

• Review of medical and social history
• Review of potential (risk factors) for depression
• Review of functional ability and level of safety
• Measurement of height, weight, body mass index, blood pressure, visual acuity screen, and other factors deemed appropriate
• Discussion of end-of-life planning, upon agreement of the individual
• Review of current opioid prescriptions
• Screening for potential substance use disorders (SUDs)
• Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (EKG, ECG)

Why provide IPPE visits to your patients?

IPPE visits are beneficial for both patients and providers. Though this visit patients learn about Medicare and their covered services, as well as disease prevention and health promotion. This visit also helps providers understand their patient's medical and social health history. Additionally, the IPPE is a revenue stream for providers.

How does the Initial Preventive Physical Examination (IPPE), also known as the “Welcome to Medicare” visit, differ from an AWV?

While the AWV is available after a Medicare patient has been enrolled in Part B for longer than 12 months, the Initial Preventive Physical Examination (IPPE) is a one-time visit covered within the first 12 months of Medicare Part B enrollment. The IPPE is an introduction to Medicare and focuses on health promotion, disease prevention, and detection.

How do I identify patients who would benefit from an IPPE?

There are different strategies that a practice may choose to use when identifying patients that are eligible for IPPE. Some practices may inform patients that they are eligible for an IPPE during a regular office visit during their first 12 months of Part B coverage. Practices wanting to achieve higher rates of IPPE among eligible patients use electronic health record (EHR) data to identify patients that qualify for IPPE.

How can I educate patients about IPPEs and what to expect?

Educating patients prior to the visit is important for achieving patient satisfaction. Patients should be aware that the IPPE is focused on prevention and is not an annual physical exam. While the IPPE is covered by Medicare without cost sharing, the patient should understand that if they discuss a medical problem during the IPPE they will be billed for the Evaluation and Management (E/M) visit and any applicable cost sharing will apply. Some practices have reported that patients sometimes present with a condition or situation at the time of their IPPE. Those practices have mitigated this issue by addressing the patient's immediate issue at that time to provide the visit with no cost sharing. Some practices provide written materials to patients explaining the differences between the IPPE, AWV, and a physical exam prior to the visit.

What are the billing codes for IPPEs?

The IPPE must be provided by a physician or qualified non-physician practitioner (nurse practitioner, physician assistant, or certified clinical nurse specialist).

There are five HCPCS codes associated with the IPPE:

• G0402: Initial preventive physical examination; face-to-face visit, services limited to new patient 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: A Federally Qualified Health Center (FQHC) visit that includes an IPPE or AWV and includes the typical bundle of services that would be furnished per diem to a Medicare patient receiving an IPPE or AWV, including all services that would otherwise be billed as a FQHC visit under G0466 or G0467.

Medicare will pay for a significant, separately identifiable, medically necessary E/M service along with the IPPE for fee-for-service providers.

How do I document IPPEs in my electronic health record (EHR)?

Many organizations have developed templates into their EHRs to capture all of the elements of the IPPE. These templates include inputs for each component of this visit, including elements required for the patient's medical and social history, depression risk factors, functional ability, exam measurements, end-of-life planning, opioid use, and SUD risk factors.

Who in my organization should I engage when designing and implementing IPPEs?

Implementing IPPEs requires broad support, beginning with the medical staff and leadership. If completing IPPEs is a priority for the practice, it will be successful. Members of the care team, from patient registration to nursing staff to the practitioner, should understand their role in the process and the workflow for completing the visit efficiently. Working with coding and billing staff early on is important for developing complete documentation and systems to bill for the service. Health information technology staff can build and refine IPPE templates and assist with queries to identify eligible patients.

How should I schedule staff to provide IPPEs?

Each practice must determine the most efficient way to schedule IPPEs. Due to the length of the IPPE, some practices designate specific time slots during the week or specific days for these types of visits.

Are there any special considerations for Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) billing for IPPEs?

IPPEs can only be provided in an RHC or FQHC setting by a practitioner that meets the RHC/FQHC definition of a visit: physician (MD or DO), nurse practitioner, physician assistant, or certified nurse midwife.

RHCs and FQHCs billing for IPPEs are reimbursed at their respective all-inclusive rate (AIR) and prospective payment system (PPS) rate. Cost sharing for patients is waived. If a significant, separately identifiable, medically necessary E/M service is provided along with the IPPE, RHCs and FQHCs are not eligible for additional payment. However, an additional AIR payment may be paid for an IPPE given by a RHC practitioner to a patient on the same day as a primary or preventive services visit.

Resources

• Medicare Wellness Visits, CMS Medicare Learning Network
• Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV), Noridian Healthcare Solutions
• The Complete Guide to the IPPE Medicare Wellness Visit, Azalea Health
• Frequently Asked Questions from the March 28, 2012 Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit, Centers for Medicare & Medicaid Services
• Medicare Claims Processing Manual, Chapter 9, Section 60.2 - Billing for FQHC Claims Paid under the PPS, Centers for Medicare & Medicaid Services

Last Updated: 11/26/2024
Last Reviewed: 11/26/2024