There is a lot of confusion when it comes to the Medicare Initial Preventive Physical Examination (IPPE) and Annual Wellness Visits (AWV). Many providers document the IPPE and Annual wellness similarly to a yearly physical exam. These services are not comprehensive physicals and require a minimal physical exam. Instead, they are a tool to assess and promote the patient’s overall health and well-being. The IPPE and Annual wellness exams have different criteria. Receiving an IPPE exam does not preclude the patient from receiving an initial annual wellness.
The IPPE (G0402), commonly known as the Welcome to Medicare Visit, is eligible for new Medicare participants within their first 12 months in the Medicare plan. Medicare recommends contacting your local MAC prior to the visit to ensure the patient is eligible for the service.
The Initial AWV (G0438) is a more comprehensive visit. It is available for patients a year (at least 11 months) after their IPPE OR if the patient is no longer within the eligibility period for the IPPE. The Subsequent AWV (G0439) is an update of information received at the initial AWV.
Below is a comparison of the documentation to support each service. The items needed for both services are italicized and bold.
IPPE (G0402)
- A review of the patients medical and social history
- A review of any potential risk factors for depression/ mood disorders
- A review of the patient’s functional abilities (i.e. Hearing, ADLs, fall risk, etc.)
- A physical exam including vitals, vision acuity and any factors of concern based on the patient’s medical and social history (i.e. if the patient has cardiovascular disease the provider may examine the extremities for vascular symptoms and the heart)
- End-of-life planning
- Education, counseling and referrals based on the patient’s history, risk factors, functional ability and exam
- Treatment plan including referrals for other age based preventative services
Initial AWV(G0438)
- A Health Risk Assessment
- List of current providers and suppliers (If you are currently the patient’s only healthcare provider, that should be noted)
- A review of the patients medical and family history
- A review of any potential risk factors for depression/ mood disorders
- A review of the patient’s functional abilities (i.e. Hearing, ADLs, fall risk, etc.)
- A physical exam including vitals, and any factors of concern based on the patient’s medical and family history (i.e. if the patient’s mother had skin cancer, the provider may check for irregular moles)
- Assessment of cognitive function
- Creation of an age relevant screening schedule
- Establish a list of risk factors and any current/recommended interventions
- Advice and counseling to reduce health risks and promote wellness
It is important to note the extent of the physical examination performed is based on the patient’s medical history and either the social or family history for the IPPE and AWV. No specific diagnosis is recommended for reporting these evaluations.
Prior to these visits, it is recommended to contact the patient and/or caregiver to encourage them to bring in personal medical records, family history and a list of their current medications/ vitamins when they present for their visit.
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