Part B Insider (Multispecialty) Coding Alert

Published on Mon Feb 23, 2015 PDF

When CMS first started allowing coverage for the initial preventive physical exam (IPPE), many practitioners trumpeted the fact that Medicare would finally allow coverage for a routine physical—but that has not been the case.

Although CMS does allow payment for the IPPE, it’s a different service from a physical, and Medicare still considers routine physical exams (99381-99397) to be non-covered services. Part B MAC NGS Medicare issued an article to differentiate between the two on Feb. 13, reminding practices about the non-reimbursable status of physicals, as well as the obvious similarities between the two.

“CMS does recognize that the IPPE may have substantial overlaps in service elements with the routine physical examinations, such as body measurement, blood pressure, and the identification and review of health status and risk factors,” NGS says in the brief.

With the IPPE, the physician furnishes education and counseling, and instigates health referrals as well as furnishing a written plan so the patient can get appropriate screenings and other services. “The IPPE is best furnished to a beneficiary when their health status is stable and they are open to discussing preventive and screening services available in Medicare,” NGS says.

To read the complete article, visit www.ngsmedicare.com.