September 1st, 2017
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Initial Preventive Physical Examination (IPPE):
|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|
Who Is Covered
All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period
- Once in a lifetime
- Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period
Medicare Beneficiary Pays
- Copayment/coinsurance waived
- Deductible waived
- Copayment/coinsurance applies
- Deductible applies
- Refer to The ABCs of the Initial Preventive Physical Examinations (IPPE) for more information.
Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.
Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.