Guide

G0402: the IPPE and its 12-month window

Summary

The Welcome to Medicare visit is billed as HCPCS G0402, the Initial Preventive Physical Examination (IPPE) — a one-time preventive benefit available only during a window early in Part B enrollment. Because the exact window, the required components, and the payment are all set in CMS's own tools and change over time, bill it by confirming three things: that the patient is still in the window, what the code pays in your locality, and whether you are also addressing a separate problem.

By Gale Editorial · Updated 2026-07-26. Every figure cited to a dated source. How we write.

How the Welcome to Medicare visit is billed

The Welcome to Medicare visit is billed as HCPCS G0402 — the Initial Preventive Physical Examination, or IPPE. It is a one-time preventive benefit for people newly enrolled in Part B, with its own defined components rather than an open-ended checkup. Because its coverage rule and payment are set in CMS's own tools and updated over time, confirm the current rule and what it pays before you bill it 13.

The IPPE is not a routine physical, which Medicare generally does not cover, and it is not the annual wellness visit, which is a separate recurring benefit. Getting the code and the benefit right is the whole task: G0402 names a specific service with specific eligibility, not a general first visit.

The eligibility window — verify it, don't remember it

The IPPE is available only during a window early in Part B enrollment — commonly described as the first twelve months of Part B — and it is a once-in-a-lifetime benefit. Rather than trust a remembered figure, confirm the current window and the visit's required elements where the rule actually lives: Medicare's Benefit Policy Manual and the Medicare Coverage Database 12. A G0402 claim for a patient outside the window will deny.

This is the single most common way the visit goes wrong: billed for someone who has been on Part B too long, or billed a second time. Checking the patient's Part B enrollment date and benefit history against the current manual rule is the step that prevents both 1. The coverage rule and any documentation requirement sit in the LCDs and NCDs searchable in that database 2.

What G0402 pays and the cost-sharing question

To see what G0402 pays, look it up in CMS's Physician Fee Schedule tool, which gives the national amount, your locality's amount, the RVUs, and the payment indicators 3. Those indicators are where you confirm how cost-sharing is treated for the code. Many Medicare preventive services sit on Medicare's zero-cost-share preventive list, carrying no coinsurance or deductible — but confirm G0402's specific treatment in the fee schedule and coverage rule rather than assuming 31.

That matters at the front desk. If you tell a patient a preventive visit is free and it turns out cost-sharing applies to part of the encounter, you have a collection problem you created. The fee-schedule indicators, checked for the exact code and date, are the honest source for what the patient owes 3.

IPPE vs the annual wellness visit vs a physical

Three things are easy to conflate. The IPPE (G0402) is a one-time visit early in Part B. The annual wellness visit is a separate, recurring preventive benefit with its own codes and frequency. And a routine physical is generally not a covered Medicare benefit at all. The awv is not a physical, and neither is the IPPE — each is a defined benefit with its own rule 1.

Confirm each benefit's rule, code, and frequency in the manual and the Medicare Coverage Database before you bill 12. The practical trap is billing an IPPE when the patient is actually due for an annual wellness visit, or the reverse — two different benefits that a quick check of the enrollment date and benefit history keeps apart.

When you also address a problem at the same visit

If you evaluate and manage a significant, separately identifiable problem during the IPPE, that office visit can be reported in addition to G0402, with the documentation supporting both services distinctly 4. The preventive IPPE elements and the problem-oriented work are different, and the note must carry each on its own terms.

The E/M level for the added visit is selected the usual way — from medical decision making or total time under the current framework 4. What you cannot do is fold a full problem evaluation into the preventive visit and bill only the IPPE, or bill a problem E/M with nothing in the note that distinguishes it from the preventive service. The documentation is what makes two services out of one encounter 4.

Telehealth, primary-payer status, and jurisdiction

Before billing an IPPE delivered remotely, check whether G0402 is payable as telehealth in the current year on CMS's list of telehealth services, which also flags audio-only eligibility 5. Telehealth coverage for specific codes changes year to year, so the list — not last year's memory — is the source.

Confirm Medicare is the primary payer for the visit through coordination of benefits, so you are not billing Medicare for a service another plan should pay first 6. And remember your MAC's local articles, searchable in the Coverage Database, carry the documentation expectations for your jurisdiction — the specific standard a reviewer applies to a G0402 claim in your state 2.

Common questions

It is HCPCS code G0402, the Initial Preventive Physical Examination (IPPE). It is a distinct preventive service with defined components, not a general physical and not the annual wellness visit. You can confirm what G0402 pays in your locality, and its payment indicators, in CMS's Physician Fee Schedule lookup, and its coverage rule in the Medicare Coverage Database.

No. The IPPE is a once-in-a-lifetime benefit tied to a window early in Part B enrollment, so a second G0402 will deny. After the IPPE window, the recurring preventive benefit is the annual wellness visit, which is separate and has its own codes. Confirm the current window and lifetime limit in Medicare's Benefit Policy Manual before billing it.

No. The IPPE (G0402) is a one-time visit available only early in Part B enrollment. The annual wellness visit is a separate, recurring benefit with its own codes and frequency. Neither is a routine physical, which Medicare generally does not cover. Because the rules differ, verify each benefit's code and frequency in the manual and Coverage Database rather than treating them as interchangeable.

Yes, if you evaluate and manage a significant, separately identifiable problem during the visit. That problem-oriented E/M can be reported in addition to G0402 when the documentation supports both services distinctly. The E/M level is selected from medical decision making or total time. The preventive IPPE work and the problem visit must each be documented on their own terms.

Check the payment indicators for G0402 in the Physician Fee Schedule lookup and the coverage rule rather than assuming. Many Medicare preventive services carry no coinsurance or deductible, but the treatment is defined per code. Confirming it in CMS's tools tells you what, if anything, the patient owes for the specific service on the date you bill it.

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References

  1. 1.Centers for Medicare & Medicaid Services (2026). Internet-Only Manuals (IOMs). Centers for Medicare & Medicaid Services (CMS). link ✓That the IPPE's coverage and billing rules — its eligibility window and required components — are set in CMS's Internet-Only Manuals (the Benefit Policy and Claims Processing Manuals), the operative instruction a provider verifies rather than recalling from memory.
  2. 2.Centers for Medicare & Medicaid Services (2026). Medicare Coverage Database (MCD) Search. Centers for Medicare & Medicaid Services (CMS). link ✓That national coverage determinations and the MACs' LCDs and articles, including documentation requirements, are searchable in the public Medicare Coverage Database — the lookup for whether and how a service like G0402 is covered in a jurisdiction.
  3. 3.Centers for Medicare & Medicaid Services (2026). Physician Fee Schedule Search. Centers for Medicare & Medicaid Services (CMS). link ✓That a clinician can find G0402's national and locality payment, RVUs, and payment indicators — including how cost-sharing is treated — in CMS's public Physician Fee Schedule lookup.
  4. 4.Centers for Medicare & Medicaid Services (2023). Evaluation and Management Services Guide. CMS Medicare Learning Network (MLN006764). link ✓That a significant, separately identifiable E/M service is selected from documented medical decision making or total time, so a problem-oriented visit can be reported alongside the IPPE when the documentation supports both.
  5. 5.Centers for Medicare & Medicaid Services (2026). List of Telehealth Services. Centers for Medicare & Medicaid Services (CMS). link ✓That CMS publishes the definitive annual list of codes payable as Medicare telehealth, including audio-only eligibility — the lookup for whether G0402 is payable when the visit is delivered remotely.
  6. 6.Centers for Medicare & Medicaid Services (2026). Coordination of Benefits and Recovery Overview. Centers for Medicare & Medicaid Services (CMS). link ✓That coordination of benefits determines the primary-versus-secondary payer order, so a provider confirms Medicare is primary for the visit before billing it.

https://www.gale.care/for-providers/mc-welcome-to-medicare-ippe · 6 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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