HCPCS Code G0402 is used to report the Initial Preventive Physical Examination (IPPE), commonly known as the “Welcome to Medicare” visit. This one-time preventive service is available to Medicare beneficiaries during the first 12 months of Part B enrollment and is designed to establish a baseline for preventive care and health risk assessment.
The IPPE focuses on health history, risk factor identification, preventive counseling, and early detection planning. It is not a comprehensive physical exam and does not include management of chronic conditions unless separately billed.
G0402 represents the preventive service itself. Problem-oriented evaluation and management (E/M) services may be billed separately when medically necessary and properly documented.
Key Facts About G0402
- Service type: Medicare preventive service
- Provider type: Physicians and qualified healthcare professionals
- Medical services included: Initial preventive physical examination (IPPE)
- Eligibility: Medicare Part B beneficiaries within first 12 months of enrollment
- Frequency: Once per lifetime
- Common components:
- Review of medical and social history
- Assessment of risk factors for disease
- Measurement of height, weight, BMI, and blood pressure
- Vision screening
- Education, counseling, and referrals for preventive services
When to Use G0402
G0402 is appropriate when:
- The patient is a new Medicare Part B enrollee within their first 12 months
- The visit is focused on preventive assessment, not chronic disease management
- The service is performed as a standalone IPPE
Examples:
- A newly enrolled Medicare patient scheduling their Welcome to Medicare visit
- Establishing baseline health data and preventive screening plans
- Identifying cardiovascular, metabolic, or lifestyle risk factors early
Documentation Requirements
To properly support G0402 billing, documentation should include:
- Confirmation of Medicare eligibility and first-year Part B enrollment
- Comprehensive medical and social history review
- Recorded vital signs and BMI
- Vision screening results
- Preventive counseling and education provided
- Referrals or orders for appropriate preventive services
If a problem-oriented E/M service is provided during the same visit, documentation must clearly distinguish preventive services from medically necessary evaluation and management.
Reimbursement and Coding Considerations
- G0402 is covered 100% by Medicare with no deductible or copay
- The service is allowed once per lifetime per beneficiary
- Additional E/M services may be billed with an appropriate modifier (when applicable)
- Chronic condition management is not included in the IPPE
- Providers should verify Medicare guidelines to ensure proper service delivery
How OptiMantra Supports Medicare Preventive Visits
OptiMantra’s integrated EMR and practice management platform helps practices efficiently deliver and document G0402 services while maintaining Medicare compliance.
With OptiMantra, providers can:
- Identify Medicare-eligible patients and track preventive visit eligibility
- Use structured templates for IPPE documentation
- Separate preventive and problem-oriented services cleanly in the EMR
- Generate compliant, audit-ready billing for Medicare preventive services
- Integrate preventive visit findings into long-term care plans
By streamlining preventive visit workflows and documentation, OptiMantra helps practices deliver high-quality Medicare care with confidence and efficiency.
Try OptiMantra for free here!
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