Initial Preventive Physical Examination

    What is the Initial Preventive Physical Examination (IPPE)?

    The Initial Preventive Physical Examination (IPPE) is also known as the “Welcome to Medicare Preventive Visit.” The IPPE is a preventive visit offered to newly-enrolled Medicare beneficiaries. Despite its name, the IPPE does not include an extensive physical examination. Rather, this service focuses on health promotion and disease prevention and detection. The IPPE is an opportunity for physicians to improve the quality of care, assist in patient engagement, and optimize payment opportunities.

    IPPE Coding

    The four HCPCS codes used to report IPPE services and ECG screenings are:

    • G0402 – IPPE is a face to face visit. Service is limited to a new beneficiary during the first 12 months of Medicare enrollment.
    • G0403 – Electrocardiogram (ECG) performed as a screening for the IPPE (with interpretation and report)
    • G0404 – ECG performed as a screening for the IPPE (tracing only without interpretation and report)
    • G0405 – ECG performed as a screening for the IPPE (interpretation and report only)

    Requirements and Components for IPPE

    Requirements and components for G0402 include:

    • Billable for the IPPE only.
      • Patients are only eligible if they are in their first 12 months of Medicare Part B coverage.
      • Medicare pays for one IPPE per beneficiary, per lifetime.
    • Review beneficiary’s medical and social family history
      • Past medical/surgical history
      • Current medications and supplements
      • Family history
      • Diet
      • Physical activity
      • History of alcohol, tobacco, and illicit drug use
      • CMS encourages close attention of opioid use, which includes opioid use disorders.
        • If the patient uses opioids, assess the benefit of other non-opioid pain therapies.
      • Review the beneficiary’s potential risk factors for depression and other mood disorders
      • Review the beneficiary’s functional ability and level of safety
        • Hearing impairment
        • Activities of daily living
        • Fall risk
        • Home safety
      • Perform an exam and obtain the following:
        • Height, weight, body mass index, and blood pressure
        • Visual acuity screen
        • Other factors deemed appropriate based on the beneficiary’s history
      • End-of-life planning, on agreement of the beneficiary
      • Educate, counsel, and refer based on results of the review and evaluation services of previous components
      • Educate, counsel, and refer for other preventive services, including:
        • A once-in-a-lifetime screening ECG, as appropriate
        • Appropriate screenings and other Medicare-covered preventive services

    Health Care Professionals Who May Furnish and Bill IPPE:

    • Physician
    • Physician assistant (PA)
    • Nurse Practitioner (NP)
    • Certified Clinical Nurse Specialist (CNS)

    Non-physicians must be legally authorized and qualified to provide the IPPE in the state in which the services are furnished.

    AAFP’s Position on IPPEs

    The AAFP supports this preventive coverage as it provides an opportunity to deliver, document, and bill for the service. Implementing the service allows physicians to invest in patient-centered, team-based care while promoting quality and cost-effective care.

    What You Need to Know

    It is important to remember that Medicare beneficiaries are only eligible for the IPPE if they are in their first 12 months of Medicare Part B coverage. After the first 12 months of coverage, beneficiaries are eligible for the Annual Wellness Visit. This benefit is covered 100% for the beneficiary.

    Approaches to Help Your Practice Get Started

    • Use this service to identify patients who would benefit from a discussion regarding their self-management health goals.
    • Choose patients which the staff has identified as likely within the first 12 months of Medicare coverage. Use this service to risk stratify your patient population.
    • Use this service to document diagnoses and conditions to accurately reflect patient severity of illness (i.e., hierarchal condition category [HCC] coding) and risk of high-cost care.