Medicare does not cover preventive services in the same way that commercial payors do. However, Medicare does have its own set of preventive services and screening that are a covered benefit. Here are some examples:
Initial Preventive Physical Examination (IPPE) – more commonly known as the Welcome to Medicare visit. This is a one-time benefit for new Medicare beneficiaries and must be performed within the first 12 months of the effective date of the patient Part B coverage. This is not a full examination but there is a checklist of documentation items that must be included. No specific diagnosis is required and the deductible and coinsurance is waived.
Annual Wellness Visit (AWV) - takes place after the patient has had their IPPE and are no longer within 12 months of their effective date for Part B. The AWV is designed to develop and update the prevention plan tailored to the patient on an ongoing basis. The initial AWV (G0438) is a one-time benefit with a checklist of items that must be performed during this visit. The subsequent AWV (G0439) maybe performed each year afterwards. It too, has a check list of that must be completed.
These visits may be performed by faculty or an APP and may be billed on the same day as another E/M services. However, there are some services that are bundled with these visits and may not be billed separately such as the depression screening.
Preventive Care and Screenings - Medicare covers some preventive services. The Novitas website has an interactive Preventive Services Chart that offers information for the covered services. It includes information such as required diagnoses and frequencies. Check it out at this link: MLN006559 – Medicare Preventive Services (cms.gov)
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