

Updates
Note: We revised this product with the following content updates:
- Review of current opioid prescriptions and screening for potential Substance Use Disorders (SUDs) during the Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AWV), and making appropriate referrals for treatment
- Medicare telehealth uses HCPCS codes G0438 and G0439

Quick Start Guide
The Annual Wellness Visits video helps health care professionals understand each of these exams and their purpose, and the requirements when submitting claims for them.
Medicare Physical Exams Coverage
Initial Preventive Physical Exam (IPPE)
Review of medical and social health history and preventive services education
✔ Covered only once within 12 months of first Part B enrollment
✔ Patient pays nothing (if provider accepts assignment)
Visit to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA)
✔ Covered once every 12 months
✔ Patient pays nothing (if provider accepts assignment)
Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury
✘ Not covered by Medicare; prohibited by statute, however, the IPPE, AWV, or other Medicare benefits cover some elements of a routine physical
✘ Patient pays 100% out-of-pocket
The term “patient” refers to a Medicare beneficiary.
Communication Avoids Confusion
As a health care provider, you may recommend patients get services more often than Medicare covers, including the AWV, or you may recommend services Medicare doesn’t cover. If this happens, please ensure patients understand they may pay some or all the cost. Communication is key to making sure patients understand why you’re recommending certain services, and whether Medicare pays for them.

Initial Preventive Physical Examination (IPPE)
The IPPE, known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. Medicare pays for 1 patient IPPE per lifetime not later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.

Annual Wellness Visit (AWV) Health Risk Assessment (HRA)
The AWV includes a HRA. See summary below of the minimum elements in the HRA. Get more information in the CDC’s A Framework for Patient-Centered Health Risk Assessments booklet, including:
- Evidence suggests HRA use and follow-up interventions can positively influence health behaviors
- Definition of the HRA framework and rationale for its use
- Guidance on HRA use, reduction of health disparities, and improving health outcomes through identifying modifiable health risks and providing behavior change interventions
- Sample HRA

IPPE, AWV, & Routine Physical – Know the Differences
IPPE
The IPPE, known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection.
Medicare pays 1 patient IPPE per lifetime not later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.
Medicare pays the IPPE costs if the provider accepts assignment.
AWV
Medicare covers an AWV that delivers Personalized Prevention Plan Services (PPPS) for patients who:
- Aren’t within 12 months after the patient’s first Medicare Part B benefits eligibility date
- Didn’t get an IPPE or AWV within the past 12 months
- Medicare pays the AWV costs if the provider accepts assignment and the deductible doesn’t apply
Routine Physical Exam
Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury
- Medicare doesn’t cover the routine physical; it’s prohibited by statute, but Medicare covers some elements of a routine physical under the IPPE, the AWV, or other Medicare benefits
- Patient pays 100% out-of-pocket

AWV/IPPE FAQs

Resources
- Advance Care Planning
- AWV/IPPE: Medicare Claims Processing Manual, Chapter 12
- AWV: Medicare Benefit Policy Manual, Chapter 15
- IPPE: Medicare Claims Processing Manual, Chapter 18, Section 80
- AWV: Medicare Claims Processing Manual, Chapter 18, Section 140
- AWV/IPPE: Medicare Diabetes Prevention Program (MDPP) Expanded Model
- CMS Roadmap Strategy to Fight the Opioid Crisis
- MLN Matters® Article SE18004, Review of Opioid Use During the IPPE and the AWV
- Reducing Opioid Misuse
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