## **What is the initial preventive physical examination (IPPE)?**
HCPCS G0402 is code for initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment. It's also called the “Welcome to Medicare” visit.
The visit incorporates a health risk assessment, which includes gathering the patient’s medical and social history, identifying risk factors for depression or other mental health conditions, and reviewing the patient’s functional ability. Preventive measures also include measuring body mass index, recording blood pressure, and screening for hearing and vision concerns. Counseling on advance care planning may also be provided as part of the visit, depending on the patient’s needs.
Preventive services can be delivered by a physician or a qualified non-physician provider, such as a nurse practitioner or certified clinical nurse specialist. The service is also covered in federally qualified health centers, ensuring broader access for Medicare beneficiaries. Guidance for the IPPE comes from national professional medical organizations, which emphasize disease prevention and health promotion rather than treatment of active illnesses.
By focusing on early detection, preventive counseling, and addressing modifiable risk factors, the IPPE helps patients and providers create a personalized roadmap for long-term health.
## **Documentation requirements**
Accurate documentation is crucial for billing G0402 to support medical necessity and coverage. Key items to include:
- Document that the visit is an IPPE.
- Record the patient's Medicare Part B effective date to ensure the visit falls within the first 12 months of patient eligibility.
- Detail all components of the IPPE, including the review of medical and family history, risk factor assessments, and the health education and counseling provided.
- Note any referrals for follow-up care or specific screenings.
- Confirm that no other evaluation and management service was performed on the same day. The IPPE is a unique service and cannot be billed alongside a regular office visit (e.g., CPT codes 99212-99215) unless a separate, distinct, and medically necessary service was provided. In that case, a modifier, such as 25, would be needed.
## **Billing requirements**
Proper billing for G0402 ensures reimbursement and compliance with payer guidelines.
- Bill using the specific billing code G0402 for the IPPE.
- Do not bill a CPT E/M code on the same day unless a separately identifiable, medically necessary service was rendered.
- Verify patient eligibility to ensure they are within their first 12 months of Medicare Part B enrollment and have not already received the IPPE.
Note: The IPPE is covered at 100% by Medicare; therefore, a cost sharing or deductible does not apply, provided it is billed correctly. A qualified healthcare professional such as a physician assistant or nurse practitioner can perform the visit.
## **Other relevant codes**
- **G0438**: Initial annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit
- **G0439**: Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit
Frequently asked questions
