G0402
Initial preventive exam
Initial Preventive Physical Examination (IPPE), commonly called the "Welcome to Medicare" visit. CMS 2026 wRVU 2.43. One-time benefit per beneficiary, performed within the first 12 months of Medicare Part B enrollment. If missed, the patient skips directly to G0438 (initial AWV) after the IPPE window closes.
IPPE (G0402), initial AWV (G0438), and subsequent AWV (G0439) are three different Medicare preventive visits. Here is the decision tree and the timing rules.
When to use it
Use G0402 for a new Medicare beneficiary within the first 12 months of Part B enrollment. The IPPE is a structured one-time preventive service: it covers medical and social history review, depression risk screening, functional ability and safety assessment, vital signs and limited exam, education and counseling on Medicare-covered preventive services, end-of-life planning offer, and a written prevention plan.
Full guidance
Eligibility is by Part B enrollment date, NOT by age 65; a patient who delayed Part B enrollment may have a different 12-month window. The IPPE is once per lifetime per beneficiary. If a same-day problem-oriented E/M is also performed, bill 99213 through 99215 with modifier 25 on the E/M and document the problem-oriented work separately.
Documentation checklist
- ✓Medical, family, and social history review including risk factor identification.
- ✓Depression risk screening (specific tool not required but a validated tool, e.g., PHQ-2, is best practice).
- ✓Functional ability and safety review: fall risk, hearing, ADLs/IADLs.
- ✓Vital signs including height, weight, BMI, and blood pressure. Limited exam.
- ✓Visual acuity screen.
- ✓Education, counseling, and referral for end-of-life planning offered (patient may decline, document the offer).
- ✓Written personalized prevention plan including schedule of recommended preventive services.
- ✓If the patient has a problem-oriented complaint addressed in the same visit, modifier 25 on the E/M with separately identifiable documentation.
Common pitfalls
- !Window is strict. 12 months from Part B enrollment, NOT from age 65. Audit checks the actual enrollment date.
- !If the IPPE window has closed, the next AWV is G0438 (initial AWV), not G0402.
- !Performing problem-oriented work without modifier 25 on the E/M. The problem-oriented work bundles into G0402 and is uncompensated.
- !Forgetting same-day add-ons: G0444 (depression screen), G0537 (ASCVD risk assessment), 99497 with modifier 33 (ACP), G0136 (SDOH).
- !Billing G0402 for a non-Medicare patient. Commercial payers do not cover G0402; commercial preventive visits use 99386 or 99387 (new patient) or 99396 or 99397 (established).
- !Missing the written prevention plan. The plan is the structural deliverable that distinguishes the IPPE from a problem-oriented E/M.
Payer notes
Medicare covers G0402 with no patient cost share. Medicare Advantage plans follow but may use proprietary G-codes for some preventive components. Commercial payers do not pay G0402. If the patient's IPPE eligibility window has expired, document that fact and proceed with G0438 instead. EHR billing systems should flag the IPPE eligibility window automatically; if not, the practice should maintain its own tracker.