

What’s Changed?
We updated the applicable medically necessary Evaluation and Management (E/M) service codes to reflect the current year’s code set and ranges.


Quick Start
The Annual Wellness Visits video helps health care professionals understand 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.
✔ New Medicare patients within 12 months of first Part B coverage period
✔ Patients pay 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
✔ Patients pay nothing (if provider accepts assignment)
Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.
✘ Medicare doesn’t cover a routine physical (it’s prohibited by statute), but the IPPE, AWV, or other Medicare benefits cover certain routine physical elements
✘ Patients pay 100% out-of-pocket
Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health:
Communication Avoids Confusion
As a health care provider, you may recommend patients get services more often than we cover, including the AWV, or you may recommend services we don’t cover. If this happens, help patients understand they may pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services, and whether we pay for them.

Initial Preventive Physical Exam
The Initial Preventive Physical Exam (IPPE), also known as the Welcome to Medicare Preventive Visit, promotes good health through disease prevention and detection. We pay for 1 patient IPPE per lifetime no later than the first 12 months after the patient’s Part B benefits eligibility date.

Annual Wellness Visit Health Risk Assessment
The Annual Wellness Visit (AWV) includes a Health Risk Assessment (HRA). See the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments booklet has more information, including a sample HRA.

IPPE, AWV, & Routine Physical: Know the Differences
IPPE
- The IPPE, also known as the Welcome to Medicare Preventive Visit, promotes good health through disease prevention and detection
- We pay for 1 patient IPPE per lifetime no later than the first 12 months after the patient’s Part B benefits eligibility date
- We pay IPPE costs if the provider accepts assignment
AWV
We cover an AWV that delivers Personalized Prevention Plan Services (PPPS) for patients who:
- Aren’t within 12 months after the patient’s first Part B benefits eligibility date
- Didn’t get an IPPE or AWV within the past 12 months
- We pay AWV costs if the provider accepts assignment
Routine Physical Exam
- Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury
- We don’t cover a routine physical (it’s prohibited by statute), but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
- Patient pays 100% out-of-pocket

FAQs

Resources
- AWV: Section 280.5 of Medicare Benefit Policy Manual, Chapter 15
- AWV: Section 140 of Medicare Claims Processing Manual, Chapter 18
- AWV & IPPE: Medicare Claims Processing Manual, Chapter 12
- AWV & IPPE: Medicare Diabetes Prevention Program Expanded Model
- CMS Opioid Resources
- IPPE: Section 80 of Medicare Claims Processing Manual, Chapter 18
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CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.