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Resource Medicare exams

What is a Medicare exam?
Here is some info from Medicare on their types of exams.
Learn what is covered in each exam?

Quick Start Guide
The Annual Wellness Visits video helps health care professionals understand each of 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
Covered only once within 12 months of first Part B enrollment
✔ Patient pays nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)
Visit to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA)
Covered once every 12 months
✔ Patient pays nothing (if provider accepts assignment)

Routine Physical Exam
Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury
Not covered by Medicare; prohibited by statute, however, the IPPE, AWV, or other Medicare benefits cover some elements of a routine physical
✘ Patient pays 100% out-of-pocket
The term “patient” refers to a Medicare beneficiary

Initial Preventive Physical Examination (IPPE)​

The IPPE, known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. Medicare pays for 1 patient IPPE per lifetime not later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.
IPPE Components IPPE Coding, Diagnosis, & Billing
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IPPE, AWV, & Routine Physical – Know the Differences​

IPPE

The IPPE, known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection.
Medicare pays 1 patient IPPE per lifetime not later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.
Medicare pays the IPPE costs if the provider accepts assignment.

AWV

Medicare covers an AWV that delivers Personalized Prevention Plan Services (PPPS) for patients who:
  • Aren’t within 12 months after the patient’s first Medicare Part B benefits eligibility date
  • Didn’t get an IPPE or AWV within the past 12 months
  • Medicare pays the AWV costs if the provider accepts assignment and the deductible doesn’t apply

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury
  • Medicare doesn’t cover the routine physical; it’s prohibited by statute, but Medicare covers some elements of a routine physical under the IPPE, the AWV, or other Medicare benefits
  • Patient pays 100% out-of-pocket



 
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