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Initial Preventive Phys. Exam Medicare

  1. Default Initial Preventive Phys. Exam Medicare
    Medical Coding Books
    How do others interpert this statement?
    "Coverage for an individual who is no longer within 12 months after effective date of his or her first Medicare Part B coverage period and has not received either an initial preventive physicalexam or AWV within the past 12 months."

    Do you need to be in Medicare a full 12 months before you are allowed this visit?

  2. #2
    Columbia, MO
    That is how I interpret the use of the G0438, the G0439 then is for every year after that visit or every year after the IPPE. Within the first 12 months you bill the IPPE. I have read a ton on this and that is what I am getting out of it. Any one else?

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    So is the G0438 code only used for the first AWV after the IPPE visit?? Then G0439 from then on? In other words you can't bill a G0438 unless its a new pt correct?

  4. Default
    If the patient is within the first 12 months of Medicare eligibility, you have to bill the IPPE exam (G0402). If the patient is over the 12 month eligibility time frame you would bill G0438. For every subsequent AWV you would bill G0439. There must be at least a year in between visits.

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