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.