Although Medicare does not cover routine physicals, there are two types of preventive visits that are payable. The first is the Initial Preventive Physical Examination (IPPE), also known as the “Welcome to Medicare Visit/Exam”. For the IPPE, the patient must be within their first 12 months of Medicare enrollment and have Medicare Part B. Medicare patients only get one IPPE visit in a lifetime. The IPPE is not subject to the Medicare deductible but the 20% coinsurance will apply.
The second type of “preventive visit” is the Annual Wellness Visit (AWV). The AWV can be performed once the Medicare patient is no longer in the first 12 months of Medicare Part B enrollment. This service cannot be performed within 12 months of an IPPE or a previous AWV service. There are two separate codes for AWV services. The first is G0438, which is for the first AWV service performed and can only be billed once in a lifetime. The second is G0439 and are subsequent AWV; these services can be billed annually. AWV services are not subject to the deductible or the 20% coinsurance. Medicare will pay the AWV visits at a 100% of the Medicare fee schedule.
Below is an example of how to bill Medicare “preventive services” for a patient with a Medicare Part B effective date of 01/01/2011.
Medicare Part B Effective Date: 01/01/2011
IPPE (G0402): 01/02/2011
AWV (G0438): 01/02/2012
AWV (G0439): 01/02/2013
AWV (G0439): 01/02/2014
FYI- You may also bill for the IPPE and AWV on the same day as a E&M visit with a 25 modifier.
More information about the AWV-https://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf
IPPE- https://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf
