Initial Preventive Physical Examination (IPPE)
The initial preventive physical examination (IPPE) is a preventive visit also known as a ‘Welcome to Medicare Preventive Visit’. Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary’s first Part B coverage period. The IPPE may be performed by a doctor of medicine or osteopathy or a qualified non-physician practitioner (nurse practitioner, physician assistant, or clinical nurse specialist).
The physician or qualified NPP shall bill HCPCS code G0402 for the IPPE performed face-to-face with the patient. The physician or entity shall bill HCPCS code G0403 for performing the complete screening electrocardiogram (EKG) that includes the tracing, interpretation, and report. The physician or entity that performs the screening EKG tracing only (without interpretation and report) shall bill HCPCS code G0404. The physician or entity that performs the screening EKG interpretation and reports only, (without the EKG tracing) shall bill HCPCS code G0405.
Applicable HCPCS Codes for IPPE
While billing for IPPE, you must report a diagnosis code. Medicare won’t require a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam. Medicare Part B covers an IPPE when performed by a physician (doctor of medicine or osteopathy) or qualified non-physician practitioner (NPP) (physician assistant [PA], nurse practitioner [NP], or certified clinical nurse specialist [CCNS]). When you provide an IPPE and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare might pay for the additional service. Report the additional CPT code (99202–99215) with modifier -25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.
You can use the following HCPCS codes to file IPPE and ECG screening claims:
- 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).
- G0468: Federally Qualified Health Center (FQHC) visit, IPPE or AWV; an fQHC visit that includes an initial preventive physical examination (IPPE) or annual wellness visit (AWV) and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving an IPPE or AWV.
Contents of Initial Preventive Physical Examination (IPPE)
The Initial Preventive Physical Examination (IPPE) includes the following:
- review of the individual’s medical and social history with attention to modifiable risk factors for disease detection,
- review of the individual’s potential (risk factors) for depression or other mood disorders,
- review of the individual’s functional ability and level of safety,
- an examination to include measurement of the individual’s height, weight, body mass index, blood pressure, a visual acuity screen, and other factors as deemed appropriate, based on the beneficiary’s medical and social history,
- end-of-life planning, upon agreement of the individual,
- education, counseling, and referral, as deemed appropriate, based on the results of the review and evaluation services described in the previous 5 elements, and
- education, counseling, and referral including a brief written plan (e.g., a checklist or alternative) provided to the individual for obtaining the appropriate screening and other preventive services, which are separately covered under Medicare Part B.
For a detailed understanding of Initial Preventive Physical Examination (IPPE), you can refer to CMS’s page on ‘Medicare Wellness Visits’. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle services. We can assist you in billing Medicare for Initial Preventive Physical Examination (IPPE) and for other services. To know more about our billing and coding services for Medicare and commercial payers, contact us at 888-357-3226 / info@medicalbillersandcoders.com
FAQs
A: The IPPE, also known as the ‘Welcome to Medicare Preventive Visit,’ is a one-time preventive service offered to Medicare beneficiaries within the first 12 months of their Part B enrollment.
A: The IPPE can be performed by a doctor of medicine or osteopathy, or a qualified non-physician practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist).
A: HCPCS code G0402 is used to bill for the face-to-face IPPE visit.
A: HCPCS code G0403 is used to bill for a complete screening electrocardiogram (EKG) during the IPPE, including tracing, interpretation, and report.
A: G0404 is used for billing only the EKG tracing, while G0405 is used for the interpretation and report of the EKG, without the tracing.
A: Medicare does not require a specific diagnosis code for IPPE billing, but you must choose one that is consistent with the patient’s exam.
A: Yes, if a medically necessary Evaluation and Management (E/M) service is provided during the IPPE, you can bill it separately using CPT codes 99202–99215 with modifier -25.
A: The IPPE includes a review of medical and social history, depression screening, functional ability evaluation, physical exam, end-of-life planning, and counseling or referrals based on findings.
A: Medical Billers and Coders (MBC) can help you accurately bill Medicare for IPPE and other services, ensuring efficient revenue cycle management. Contact us at 888-357-3226 or info@medicalbillersandcoders.com for more information.
