At its core, the Initial Preventative Physical Examination, or IPPE, is a review of all medical and social health history with additional preventive services and healthcare education. However, the IPPE does not include an extensive physical examination. This ‘exam’ or service, focuses more on health promotion and disease prevention and detection. The IPPE is an opportunity for physicians to improve the patient’s quality of care, create care coordination plans, and illuminate any health concerns.
As many providers are aware, Rural communities have higher rates of chronic diseases and illnesses. But patients have less access to care and healthcare education. Many patients wait a long time to treat their illness, or don’t come into their nearest Rural Health Clinic until they are already sick. That’s why exams like the IPPE are so crucial to improving patient care and quality of life. Know that the patient engagement and education component to this exam can be done in tandem with other visits. The IPPE is an opportunity to create change in the community through preventative medicine.
The IPPE is known as the “Welcome to Medicare” preventive visit. Medicare pays for 1 patient IPPE per lifetime, no later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.
During a visit, you might recommend that a patient receives these services more often than Medicare offers, or you might recommend additional services that Medicare doesn’t cover. If this is the case, please ensure that patients understand they may pay some or all the cost. Communication is key to making sure patients understand why you’re recommending certain services, and whether Medicare pays for them.
According to the 2019 Rural Health IT Survey, declining reimbursements along with improving billing processes and managing denials are two of the top three pain points healthcare organizations face.
Download our guide to learn more about managing denials, charge captures, and patient collections.
Use these HCPCS codes to file IPPE and ECG/EKG screening claims:
G0402 – Initial preventive physical examination; face-to-face visit, services limited to new
beneficiary 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 – Federally qualified health center (fqhc) visit, ippe or awv; a 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
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You must report a diagnosis code when submitting an IPPE claim. Medicare doesn’t require you to document a 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:
When you provide an IPPE along with a separately identifiable and medically necessary Evaluation and Management (E/M) service, Medicare might help cover the E/M service. Report the additional CPT code (99201–99215) with modifier –25.
No. The IPPE isn’t a routine physical that some older adults may get periodically from their physician or other qualified Non-Physician Practitioner (NPP). This exam is an introduction to Medicare and its covered benefits. Additionally, it focuses on health promotion, disease prevention, and detection to help patients stay well. The SSA explicitly prohibits Medicare coverage for routine physical examinations.
No. The IPPE doesn’t include clinical laboratory tests, but you may make appropriate referrals for these tests as part of the IPPE.
No. The IPPE doesn’t include clinical laboratory tests, but you may make appropriate referrals for these tests as part of the IPPE.
No. Medicare waives both the coinsurance/copayment and the Medicare Part B deductible for the IPPE (HCPCS code G0402).
Neither is waived for the screening electrocardiogram (ECG/EKG) (HCPCS codes G0403, G0404, or G0405).
A patient who hasn’t had an IPPE and whose initial enrollment in Medicare Part B began in 2020 is eligible for an IPPE in 2021, as
long as it’s within 12 months of the patient’s first Medicare Part B enrollment effective date.
