{"id":16134,"date":"2022-12-22T14:07:29","date_gmt":"2022-12-22T14:07:29","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=16134"},"modified":"2026-05-11T14:48:38","modified_gmt":"2026-05-11T14:48:38","slug":"billing-medicare-for-initial-preventive-physical-examination","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-medicare-for-initial-preventive-physical-examination\/","title":{"rendered":"Billing Medicare for Initial Preventive Physical Examination"},"content":{"rendered":"

Initial Preventive Physical Examination (IPPE)<\/span><\/h2>\n

The initial preventive physical examination (IPPE) is a preventive visit also known as a \u2018Welcome to Medicare Preventive Visit\u2019. Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary\u2019s 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).<\/span><\/p>\n

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.<\/span><\/p>\n

Applicable HCPCS Codes for IPPE<\/span><\/h2>\n

While billing for IPPE, you must report a diagnosis code. Medicare won\u2019t require a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient\u2019s 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\u201399215) with modifier -25. That portion of the visit must be medically necessary and reasonable to treat the patient\u2019s illness or injury or to improve the functioning of a malformed body part.<\/span><\/p>\n

You can use the following HCPCS codes to file IPPE and ECG screening claims:<\/span><\/p>\n