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March 1, 2013 – Updated 01.10.23

Annual Wellness Visits (AWVs) and Initial Preventive Physical Examinations (IPPEs) versus "Routine Examinations"

Medicare may cover two specialized physical examination services for eligible beneficiaries: the Initial Preventive Physical Examination (IPPE) and an Annual Wellness Visit (AWV). When eligible for Medicare reimbursement, these services are covered at no cost to beneficiaries; coinsurance and deductible do not apply. There are specific required elements and coverage criteria for both IPPEs and AWVs.

In general, Medicare does not pay for "routine examinations." These services are designated as status N in the Medicare Physician Fee Schedule Database (MPFSDB) and are never reimbursed by Medicare. It is important to note that these CPT codes are not appropriate codes for submitting AWV or IPPE services.

Examination Type Procedure Code Tips
"Routine examination" CPT codes 99391-99397
  • Never reimbursed by Medicare
Initial Preventive Physical Examination (IPPE) HCPCS code G0402
  • One-time service
  • Within first 12 months of beneficiary's Medicare effective date
  • 9 required components
Annual Wellness Visit (AWV): initial HCPCS code G0438
  • May be covered once
  • 13 required components
Annual Wellness Visit (AWV): subsequent HCPCS code G0439
  • May be covered once per year
  • 11 required components

Initial Preventive Physical Examination (IPPE)

Medicare provides coverage for an IPPE for patients who have been enrolled in Medicare for less than one year. It is a one-time service, intended to help introduce insurance coverage, benefits, and give appropriate screening for disease detection and promote preventive health. The IPPE must be performed within the first 12 months after the effective date of the beneficiary's Medicare Part B coverage.

An IPPE includes the following nine components:

  • A review of the beneficiary's medical and social history
  • Review of the beneficiary's potential risk factors for mood disorders
  • Review of the beneficiary's functional ability and level of safety
  • An examination
  • End-of-life planning
  • Review current opioid prescriptions
  • Screen for potential substance use disorders (SUDs)
  • Education, counseling, and referral based on the previous five components
  • Education, counseling, and referral for other preventive services

Annual Wellness Visit (AWV)

Medicare provides coverage for an AWV for patients who are enrolled in Medicare. This service may be covered as often as once per year. There are two specific types of AWV: initial and subsequent.

Required components for the initial AWV include:

  • Perform a Health Risk Assessment (HRA)
  • Establishment of the beneficiary's medical/family history
  • Review of the beneficiary's potential risk factors for depression and/or other mood disorders
  • Review of the beneficiary's functional ability and level of safety
  • Establishment of current providers and suppliers of service
  • Obtain height, weight, body mass index (BMI), blood pressure and other appropriate routine measurements
  • Detection of any cognitive impairment that the beneficiary may have
  • Establishment of a written screening schedule for the beneficiary
  • Establishment of a list of risk factors and conditions for which the primary, secondary, or tertiary interventions are recommended for the beneficiary
  • Furnishing personalized health advice to the beneficiary, and a referral for further care, if appropriate
  • Provide Advance Care Planning (ACP) services (optional)
  • Review current opioid prescriptions
  • Screen for potential substance use disorders (SUDs)

The subsequent AWV visit will be updating the patient's history as established during the initial visit, as well as a new assessment to establish any needed additional treatment. This is a shorter established service. Required components for subsequent AWVs include:

  • Review and update of the HRA
  • An update of the beneficiary's medical/family history
  • Update of the list of current providers and suppliers of service
  • Obtain height, weight, body mass index (BMI), blood pressure and other appropriate routine measurements
  • Detection of any cognitive impairment that the beneficiary may have
  • Update of the written screening schedule for the beneficiary
  • Update of the list of risk factors and conditions for which the primary, secondary, or tertiary interventions are recommended for the patient
  • Furnish and update personal health advice and appropriate referrals for further care, if appropriate
  • Provide Advance Care Planning (ACP) services (optional)
  • Review current opioid prescriptions
  • Screen for potential substance use disorders (SUDs)

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