Check Date Before Taking On ‘Welcome to Medicare’ Claims

Posted on 18 Sep, 2015 |comments_icon 2|By Chris Boucher

Remember, this exam is a one-time benefit for patients.

Reporting your patients’ “Welcome to Medicare” initial preventive physical examinations (IPPE) seems straightforward enough. There are a couple of coding concerns you should keep in mind when reporting these services, however.

Do this: Make sure your “Welcome …” claims are embraced every time you file them by following these quick tips.

Be Sure Patient Is With Medicare

Since the “Welcome …” exam is a Medicare benefit, you must be sure that the patient is a Medicare beneficiary – or has insurance that follows Medicare’s billing rules. If you’re unsure how to code an IPPE, check with the payer before filing the claim.

Check Patient’s Date of Enrollment

For most “Welcome to Medicare” exams, you should report G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment).

2 caveats: Report G0402 only when the patient’s IPPE occurs less than 12 months after her date of Medicare enrollment. Also, patients are only eligible for G0402 if they haven’t had an IPPE since enrolling with Medicare.

Alternative: If the patient has been enrolled in Medicare for more than 12 months, you might report a code such as G0438 (Annual wellness visit; includes a personalized prevention plan of service, initial visit) or G0439 (Annual wellness visit; includes a personalized prevention plan of service, subsequent visit) rather than G0402. Check your payer’s policy if you’re unsure how to code for these services.

Code for Other Allowable Services

There are services the physician might provide during an IPPE that you could code for separately, depending on the payer’s specific policy. For example, many Medicare payers consider an EKG during an IPPE a separately reportable service.

Best bet: Dig into your payer contracts to see what services are separately reportable during Medicare IPPEs.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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