The Initial Preventive Physical Examination (IPPE), commonly known as the "Welcome to Medicare" visit, is billed using G0402. It is the very first preventive visit a Medicare beneficiary is eligible for.
The 12-Month Eligibility Window
You can ONLY bill G0402 within the first 12 months of the patient's effective date of Medicare Part B coverage. If the patient is on day 366 of Part B coverage, this code will deny, and you must bill the Initial AWV (G0438) instead.
| Code | Description | Eligibility Window |
|---|---|---|
| G0402 | Initial preventive physical examination; face-to-face visit | First 12 months of Part B |
EKG Requirement Differences
The IPPE includes education and counseling regarding an EKG, but the actual performance of the screening EKG is billed separately using G0403 (complete), G0404 (tracing only), or G0405 (interpretation and report).
NCCI Edits
Do not bill G0402 and an AWV (G0438/G0439) on the same claim. If an abnormality is found requiring a full E/M evaluation, bill the E/M code with Modifier 25. Run your edits carefully.