Initial Preventive Physical Examination with EKG (IPPE)

Welcome to Medicare Preventive Visit

HCPCS/CPT Codes

• G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

• G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

• G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

• G0405 – Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Who Is Covered

• All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period

Frequency

• Once in a lifetime
• Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

Covered ICD-10 Codes for CPT G0402

The specified below ICD codes are covered for CPT G0402 but may not be limited and some private payers having specific guidelines.

• R93.811 Abnormal radiologic findings on diagnostic imaging of right testicle
• R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle
• R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral
• R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle
• R93.89 Abnormal findings on diagnostic imaging of other specified body structures
• Z00.00 Encounter for general adult medical examination without abnormal findings
• Z00.01 Encounter for general adult medical examination with abnormal findings
• Z00.8 Encounter for other general examination
• Z01.00 Encounter for examination of eyes and vision without abnormal findings
• Z01.01 Encounter for examination of eyes and vision with abnormal findings
• Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings
• Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
• Z01.10 Encounter for examination of ears and hearing without abnormal findings
• Z01.110 Encounter for hearing examination following failed hearing screening
• Z01.118 Encounter for examination of ears and hearing with other abnormal findings
• Z68.1 Body mass index [BMI] 19.9 or less, adult
• Z68.20 Body mass index [BMI] 20.0-20.9, adult
• Z68.21 Body mass index [BMI] 21.0-21.9, adult
• Z68.22 Body mass index [BMI] 22.0-22.9, adult
• Z68.23 Body mass index [BMI] 23.0-23.9, adult
• Z68.24 Body mass index [BMI] 24.0-24.9, adult
• Z68.25 Body mass index [BMI] 25.0-25.9, adult
• Z68.26 Body mass index [BMI] 26.0-26.9, adult
• Z68.27 Body mass index [BMI] 27.0-27.9, adult
• Z68.28 Body mass index [BMI] 28.0-28.9, adult
• Z68.29 Body mass index [BMI] 29.0-29.9, adult
• Z68.30 Body mass index [BMI] 30.0-30.9, adult
• Z68.31 Body mass index [BMI] 31.0-31.9, adult
• Z68.32 Body mass index [BMI] 32.0-32.9, adult
• Z68.33 Body mass index [BMI] 33.0-33.9, adult
• Z68.34 Body mass index [BMI] 34.0-34.9, adult
• Z68.35 Body mass index [BMI] 35.0-35.9, adult
• Z68.36 Body mass index [BMI] 36.0-36.9, adult
• Z68.37 Body mass index [BMI] 37.0-37.9, adult
• Z68.38 Body mass index [BMI] 38.0-38.9, adult
• Z68.39 Body mass index [BMI] 39.0-39.9, adult
• Z68.41 Body mass index [BMI] 40.0-44.9, adult
• Z68.42 Body mass index [BMI] 45.0-49.9, adult
• Z68.43 Body mass index [BMI] 50.0-59.9, adult
• Z68.44 Body mass index [BMI] 60.0-69.9, adult
• Z68.45 Body mass index [BMI] 70 or greater, adult
• Z71.84 Encounter for health counseling related to travel

Covered ICD-10 Codes for CPT G0403, G0404, G0405

The specified below ICD codes are covered for CPT G0403, G0404, G0405 but may not be limited and some private payers having specific guidelines.

• R00.0 Tachycardia, unspecified
• R00.1 Bradycardia, unspecified
• R00.2 Palpitations
• R00.8 Other abnormalities of heart beat
• R00.9 Unspecified abnormalities of heart beat
• R01.0 Benign and innocent cardiac murmurs
• R01.1 Cardiac murmur, unspecified
• R01.2 Other cardiac sounds
• R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
• R07.1 Chest pain on breathing
• R07.2 Precordial pain
• R07.81 Pleurodynia
• R07.82 Intercostal pain
• R07.89 Other chest pain
• R07.9 Chest pain, unspecified
• R94.31 Abnormal electrocardiogram [ECG] [EKG]
• Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
• Z13.31 Encounter for screening for depression
• Z13.32 Encounter for screening for maternal depression
• Z13.39 Encounter for screening examination for other mental health and behavioral disorders
• Z13.6 Encounter for screening for cardiovascular disorders
• Z82.41 Family history of sudden cardiac death
• Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system

Medicare Beneficiary Pays as below,

G0402,

• Co-payment/coinsurance waived
• Deductible waived

G0403, G0404, and G0405,

• Co-payment/coinsurance applies
• Deductible applies