Coding the Welcome to Medicare Visit (IPPE)
Need help coding Welcome to Medicare Visits? Here's what you need to know to get paid for the IPPE.
What is the Initial Preventive Physical Examination?
The Initial Preventive Physical Examination (IPPE), also known as the Welcome to Medicare Preventive Visit, is offered to newly-enrolled Medicare beneficiaries. The IPPE focuses on health promotion and disease prevention and detection. Despite its name, the IPPE does not include an extensive physical examination.
Purpose and benefits of the IPPE
Implementing the service allows physicians to invest in patient-centered, team-based care while promoting quality and cost-effective care. For patients, it's an opportunity to make sure they are up-to-date on important screenings and get familiar with Medicare's covered services.
What’s included in the Welcome to Medicare Exam
| Component | Details |
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Medical and social family history |
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Functional and safety assessment |
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Behavioral and mental health screening |
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Physical exam |
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End-of-life planning |
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Education, counseling and referral based on health needs |
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Education, counseling and referral for other preventive services |
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HCPCS codes for the IPPE
The four Healthcare Common Procedure Coding System (HCPCS) codes used to report IPPE services and electrocardiogram (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: 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).
Use of modifier 25 when applicable
Medicare allows payment for G2211 when the base evaluation and management service is appended with modifier 25 and provided on the same date as an annual wellness visit, IPPE, vaccine or other preventive services covered by Medicare.
Geriatric medicine CME
Tips for the Welcome to Medicare Exam
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., hierarchical condition category coding) and risk of high-cost care.
After the first 12 months, beneficiaries are eligible for the Annual Wellness Visit. This benefit is covered 100% for the beneficiary.