Georgia Medicare IPPE Welcome to Medicare Visit 2026

The Medicare Initial Preventive Physical Examination, commonly called the "Welcome to Medicare" visit, gives every newly Medicare-enrolled Georgia beneficiary the right, once in their Medicare lifetime within the first twelve months of Medicare Part B enrollment, to a comprehensive preventive visit with a qualified primary care provider focused on health risk assessment, identification of risk factors for chronic disease, end-of-life planning discussion, review of current medications including opioid prescriptions, screening for substance use disorders, and a structured introduction to the broader Medicare preventive services framework that will be available to the beneficiary going forward. The IPPE is billed under HCPCS G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first twelve months of Medicare enrollment), with an optional one-time electrocardiogram add-on billed under HCPCS G0403 (global EKG), G0404 (tracing only), or G0405 (interpretation only), at zero out-of-pocket cost to the beneficiary under the Affordable Care Act Section 4104 preventive services cost-sharing waiver.

The IPPE benefit has a layered legislative history that distinguishes it from most other Medicare preventive services. The IPPE was the first dedicated Medicare preventive visit, established under Section 611 of the Medicare Modernization Act, codified as Section 1861(ww) of the Social Security Act. The MMA framework structured the IPPE as a focused preventive encounter for the newly Medicare-enrolled population, recognizing that the transition into Medicare coverage represented a critical opportunity to identify health risks, document preferences, and establish a coordinated preventive care plan. The original IPPE included a one-time EKG add-on reflecting an emphasis on cardiovascular risk assessment in the newly Medicare-eligible population.

The IPPE was substantially expanded by Section 101(a) of the Medicare Improvements for Patients and Providers Act 2008 (MIPPA). The MIPPA 2008 expansion updated the IPPE required components to include vital signs documentation, body mass index measurement, end-of-life planning discussion, and an expanded written plan of education and counseling that included screening tests and other preventive services. The MIPPA 2008 expansion brought the IPPE into closer alignment with what would later become the Annual Wellness Visit framework, a coordinated preventive encounter that systematically addresses multiple risk factors and produces a structured prevention plan. The same MIPPA legislation that expanded the IPPE also created the Section 1861(ddd) additional preventive services authority that would later be used to establish behavioral counseling and screening services including alcohol misuse screening, depression screening, IBT for cardiovascular disease, IBT for obesity, STIs screening, MDPP, and the expanded tobacco cessation counseling framework.

The IPPE was further updated by the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act of 2018). Section 6086 of the SUPPORT Act required CMS to include in the IPPE a review of current opioid prescriptions and a screening for substance use disorders including alcohol, tobacco, and illicit drug use. The SUPPORT Act updates reflected congressional concern about the opioid crisis and the importance of screening newly Medicare-enrolled beneficiaries for substance use risks at the entry point to Medicare coverage. The SUPPORT Act updates were operationalized through CMS rulemaking and took effect for IPPEs furnished on or after January 1, 2019.

The IPPE's defining structural feature is its once-in-a-lifetime frequency limit within the first twelve months of Medicare Part B enrollment. This frequency framework distinguishes the IPPE from every other Medicare preventive service. Beneficiaries who do not complete the IPPE within the first twelve months of Part B enrollment lose IPPE eligibility permanently. The benefit cannot be furnished later. Beneficiaries who do complete the IPPE within the eligibility window remain eligible for the Annual Wellness Visit beginning twelve months after Part B enrollment, ensuring continuity of preventive care coordination after the IPPE eligibility period ends.

For Georgia Medicare beneficiaries, the IPPE benefit operates within a state landscape that includes substantial primary care infrastructure delivering IPPE. Tens of thousands of Georgia residents become newly Medicare-eligible each year through age-based eligibility at 65, with additional newly eligible beneficiaries entering through Social Security Disability Insurance and end-stage renal disease pathways. The Georgia primary care delivery network, including major academic medical centers (Emory Healthcare, Wellstar Health System, Piedmont Healthcare, Northside Hospital, Augusta University Health, Atrium Health Navicent, Memorial Health), community primary care, the federally qualified health center network, and rural primary care including critical access hospitals and rural health clinics, provides IPPE delivery. Telehealth IPPE delivery expanded substantially during the COVID-19 public health emergency and has continued in modified form, providing an important access pathway for rural Georgia beneficiaries who may face primary care workforce constraints in their county of residence.

This guide explains how the Medicare IPPE benefit works, what eligibility looks like for a newly Medicare-enrolled Georgia beneficiary, what the required components entail, how the HCPCS G0402 coding framework operates, how the once-in-a-lifetime within twelve months frequency limit works, and what the Georgia IPPE delivery landscape provides.

By Brevy Care Team · Last verified May 14, 2026

The Federal Framework Underlying the Medicare IPPE Benefit

Section 1861(ww) of the Social Security Act: IPPE Authority Added by MMA Section 611

The statutory foundation is Section 1861(ww) of the Social Security Act, codified at 42 U.S.C. 1395x(ww), added by Section 611 of the Medicare Modernization Act. Section 611 of the MMA established the IPPE as the first dedicated Medicare preventive visit. The MMA framework structured the IPPE as a focused preventive encounter for the newly Medicare-enrolled population.

MMA 2003 Original Framework

The MMA 2003 original IPPE framework included:

• Once-in-a-lifetime visit within the first six months of Medicare Part B enrollment (later expanded to twelve months by MIPPA 2008)
• Required components including medical and social history, depression risk factor identification, functional ability and safety review, and education and counseling
• One-time electrocardiogram (EKG) add-on coverage reflecting an emphasis on cardiovascular risk assessment

MIPPA 2008 Section 101 Expansion

Section 101(a) of the Medicare Improvements for Patients and Providers Act 2008 (MIPPA) substantially expanded the IPPE in several ways:

• Twelve-month enrollment window: The IPPE eligibility window was expanded from the first six months of Part B enrollment to the first twelve months, providing newly Medicare-enrolled beneficiaries more time to schedule and complete the IPPE.
• Vital signs documentation: Required components were expanded to include vital signs documentation.
• Body mass index measurement: BMI calculation added as a required component, supporting obesity screening and downstream IBT for obesity referral.
• End-of-life planning discussion: Required components added a structured end-of-life planning discussion, the precursor to what would later become the standalone Advance Care Planning add-on (CPT 99497).
• Expanded written plan of education and counseling: The written plan was expanded to include screening tests and other preventive services, bringing the IPPE into closer alignment with what would later become the Personalized Prevention Plan Service of the Annual Wellness Visit.

The same MIPPA 2008 legislation that expanded the IPPE also created the Section 1861(ddd) additional preventive services authority through Section 101(a) of the act. The Section 1861(ddd) authority would subsequently be used to establish multiple preventive services including alcohol misuse screening (NCD 210.8), depression screening (NCD 210.9), STIs screening and HIBC (NCD 210.10), IBT for cardiovascular disease (NCD 210.11), IBT for obesity (NCD 210.12), the expanded tobacco cessation counseling under NCD 210.4.1, HCV screening (NCD 210.13), MDPP, and others.

SUPPORT Act 2018 Section 6086 Updates

The Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act) further updated the IPPE through Section 6086. The SUPPORT Act updates required CMS to include in the IPPE:

• Review of current opioid prescriptions: assessment of current opioid prescriptions including dose, duration, indication, and consideration of alternatives, tapering, or naloxone prescription.
• Screening for substance use disorders: screening for alcohol use disorder, tobacco use, and illicit drug use using validated screening instruments.

The SUPPORT Act updates were operationalized through CMS rulemaking and took effect for IPPEs furnished on or after January 1, 2019. The updates reflected congressional concern about the opioid crisis and the importance of screening newly Medicare-enrolled beneficiaries for substance use risks.

42 CFR 410.16: IPPE Implementing Regulations

42 CFR 410.16 implements the Section 1861(ww) framework through specific regulations defining the IPPE's required components, eligible provider types, frequency limits, and coding framework. The regulation has been updated multiple times to reflect the MIPPA 2008 expansion and the SUPPORT Act 2018 updates.

HCPCS G0402: Initial Preventive Physical Examination

HCPCS G0402 is defined as "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first twelve months of Medicare enrollment." The code is used once per beneficiary for the IPPE encounter.

HCPCS G0403, G0404, and G0405: One-Time EKG Add-On

The IPPE includes coverage for a one-time screening electrocardiogram billed under three component codes:

• 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.

The EKG add-on is once-in-a-lifetime as part of the IPPE encounter. The EKG codes are used only when the screening EKG is performed; beneficiaries who do not have the screening EKG do not have these codes billed.

ACA Section 4104: Cost-Sharing Waiver

Section 4104 of the Affordable Care Act waives the Part B deductible and the twenty percent coinsurance for Medicare preventive services aligned with USPSTF Grade A or Grade B recommendations and specifically designated by CMS. The IPPE is among the preventive services covered under the waiver. Cost-sharing for the IPPE is zero out-of-pocket.

The IPPE Required Components in Detail

The IPPE required components, as expanded by MIPPA 2008 and updated by the SUPPORT Act 2018, include:

Medical and Social History Review

The medical and social history review documents:

• Past medical history: prior diagnoses, surgeries, hospitalizations, significant medical events.
• Family medical history: conditions with genetic or familial components (CVD, cancers, diabetes, dementia, mental health conditions).
• Social history: occupational history, education, current living situation, social support, marital status, family structure.
• Tobacco use history: current and former use, type of tobacco products, quantity, duration, prior cessation attempts.
• Alcohol use history: current and former use, quantity, pattern (incorporating AUDIT-C or SASQ screening).
• Illicit drug use history: current and former use of illicit substances (updated under SUPPORT Act 2018).
• Physical activity: current activity level, exercise patterns, limitations.
• Nutrition: dietary patterns, food security, special dietary considerations.
• Sexual health: relevant for STI screening eligibility and HIBC referral.

Potential Risk Factors for Depression Identification

The IPPE includes specific identification of potential risk factors for depression, which may include:

• Use of structured depression screening instrument (PHQ-2 or PHQ-9)
• Clinical observation and interview
• Documentation of risk factors including recent loss, isolation, chronic illness burden, prior depression history, family history

Identification of depression risk factors during the IPPE coordinates with the Section 1861(ddd) depression screening benefit under NCD 210.9, with follow-up under HCPCS G0444 if structurally separate from the IPPE.

Functional Ability and Safety Review

The functional ability and safety review addresses:

• Activities of daily living (ADLs): bathing, dressing, toileting, transferring, continence, eating.
• Instrumental activities of daily living (IADLs): managing medications, finances, transportation, shopping, food preparation, housework.
• Fall risk: history of falls in prior year, gait and balance assessment.
• Hearing impairment screening: screening question or whisper test.
• Vision impairment screening: included specifically as visual acuity screening (Snellen chart or equivalent).
• Home safety: home environment hazards, medication storage, fire safety.
• Driving safety: driving status, recent crashes or concerns.

Vital Signs Documentation

Vital signs documentation includes:

• Height (for BMI calculation and baseline)
• Weight (for BMI calculation, weight trends)
• Body mass index (BMI): added as required component by MIPPA 2008 expansion
• Blood pressure (for hypertension screening per USPSTF Grade A)
• Visual acuity screening: included specifically as IPPE vital signs component

End-of-Life Planning Discussion

End-of-life planning discussion was added as a required IPPE component by MIPPA 2008. The discussion includes:

• Beneficiary's preferences regarding healthcare decision-making
• Advance directive completion status
• Healthcare proxy designation
• Code status preferences
• Living will or healthcare directive considerations
• Palliative care and hospice care education

The end-of-life planning discussion during the IPPE is the precursor to what would later become the standalone Advance Care Planning add-on (CPT 99497). The IPPE end-of-life planning discussion is included within the G0402 framework without separate billing; the Advance Care Planning CPT 99497 is billable separately when furnished outside the IPPE context or as an AWV add-on.

Review of Current Opioid Prescriptions (SUPPORT Act 2018)

The SUPPORT Act 2018 added review of current opioid prescriptions as a required IPPE component effective January 1, 2019. The review includes:

• Documentation of all current opioid prescriptions including drug, dose, frequency, duration, indication, prescriber
• Assessment of opioid use disorder risk factors (history of substance use disorder, mental health comorbidities, chronic pain management approach)
• Consideration of alternative pain management (non-opioid pharmacotherapy, physical therapy, behavioral approaches)
• Consideration of opioid dose tapering or discontinuation where clinically appropriate
• Naloxone prescription consideration for beneficiaries on chronic opioid therapy
• Coordination with prescribing providers and pharmacy

Screening for Substance Use Disorders (SUPPORT Act 2018)

The SUPPORT Act 2018 added screening for substance use disorders as a required IPPE component effective January 1, 2019. The screening includes:

• Alcohol use disorder screening: structured instrument (AUDIT-C, SASQ, single-question screen) consistent with the Section 1861(ddd) alcohol misuse screening benefit under NCD 210.8.
• Tobacco use screening: current tobacco use status and tobacco-related concerns coordinated with the tobacco cessation counseling benefit under NCD 210.4.1.
• Illicit drug use screening: current and recent illicit drug use including marijuana, cocaine, methamphetamine, prescription drug misuse, and other illicit substances.

Positive substance use disorder screening during the IPPE triggers referrals to appropriate treatment services including SBIRT counseling for alcohol misuse (G0442/G0443), tobacco cessation counseling (CPT 99406/99407), opioid treatment programs (covered under Medicare since the SUPPORT Act 2018 Section 2005), and behavioral health services.

Written Plan of Education and Counseling

The written plan of education and counseling, expanded by MIPPA 2008, includes:

• Screening tests and other preventive services: structured list of recommended preventive services the beneficiary should receive going forward, including age-appropriate cancer screenings (colorectal, mammography, prostate, cervical, lung), cardiovascular and diabetes screening, immunizations, and other preventive services.
• Education on identified risk factors: tailored education on the beneficiary's specific risk factors including cardiovascular risk, diabetes risk, fall risk, mental health risk, substance use risk.
• Counseling on healthy behaviors: tobacco cessation if applicable, physical activity recommendations, nutrition recommendations, alcohol use moderation, medication adherence.
• Referrals to specialty care: as appropriate based on IPPE findings.

The written plan is documented and provided to the beneficiary, with copies retained in the medical record.

The Once-in-a-Lifetime Within First 12 Months Frequency Framework

The IPPE's distinctive frequency framework (once-in-a-lifetime within the first twelve months of Medicare Part B enrollment) creates both opportunity and risk:

Opportunity

For newly Medicare-enrolled beneficiaries, the IPPE provides a structured introduction to Medicare preventive services at the entry point to Medicare coverage. The IPPE's comprehensive component structure surfaces risk factors and conditions that may not have been previously addressed, and the written plan of education and counseling creates a roadmap for the beneficiary's preventive care going forward.

Risk

Beneficiaries who do not complete the IPPE within the first twelve months of Part B enrollment lose IPPE eligibility permanently. The benefit cannot be furnished later. Beneficiaries who miss the IPPE window remain eligible for the Annual Wellness Visit beginning twelve months after Part B enrollment, but the AWV begins from a less comprehensive baseline assessment than the IPPE would have provided.

Scheduling Considerations

To maximize IPPE utilization, beneficiaries should:

• Schedule IPPE within the first three to six months of Part B enrollment (allowing adequate scheduling lead time and providing time for follow-up if issues are identified)
• Identify a primary care provider who furnishes IPPE (most Medicare-enrolled primary care providers furnish IPPE)
• Bring complete medications list, prior medical records, and questions to the IPPE
• Allow approximately 45 to 60 minutes for the IPPE, longer if EKG is included

Eligible Providers for IPPE

IPPE may be furnished by:

• Physicians (MD or DO): family medicine, internal medicine, geriatric medicine, and other specialties
• Nurse practitioners (NPs): practicing in primary care or specialty roles
• Physician assistants (PAs): practicing in primary care or specialty roles
• Clinical nurse specialists (CNSs): practicing in primary care or specialty roles

IPPE may be furnished in:

• Primary care office settings
• Multispecialty group practices
• Hospital outpatient departments
• Federally qualified health centers (FQHCs)
• Rural health clinics (RHCs)
• Other Medicare-enrolled provider settings

Telehealth IPPE Delivery

Medicare telehealth coverage for the IPPE expanded substantially during the COVID-19 public health emergency. CMS continued telehealth IPPE in modified form following the PHE. Current telehealth IPPE delivery generally includes:

• Audio-video synchronous telehealth visits where the beneficiary uses a smartphone, tablet, or computer with video capability and Internet connection
• Certain audio-only telehealth visits in defined circumstances
• Originating site location flexibility allowing the beneficiary to participate from home

Telehealth IPPE is particularly important for rural Georgia counties where in-person IPPE access may be constrained. Telehealth IPPE requires that the provider can adequately complete the required IPPE components remotely, which may pose challenges for components requiring physical examination (vital signs, visual acuity screening). These components may be obtained through home measurement reported during the encounter, delegated in-person measurement at a clinic or pharmacy, or prior measurements within an appropriate time window. The one-time EKG add-on under G0403/G0404/G0405 cannot be furnished via telehealth and would require in-person follow-up if elected.

IPPE Coordination With AWV and Downstream Preventive Services

The IPPE serves as the initial entry point into the broader Medicare preventive services framework, with coordination at multiple points:

IPPE-AWV Coordination

The IPPE and the AWV are coordinated but distinct benefits:

• IPPE (G0402) is once-in-a-lifetime within the first twelve months of Part B enrollment, focused on initial Medicare welcome and entry assessment.
• AWV (G0438 Initial, G0439 Subsequent) is annually renewable beginning twelve months after Part B enrollment, focused on ongoing risk assessment and prevention coordination.

Beneficiaries who complete the IPPE remain eligible for the AWV beginning twelve months after Part B enrollment. The IPPE eligibility does not preclude the Initial AWV at the twelve-month mark.

Downstream Section 1861(ddd) Preventive Services

The IPPE serves as the entry point for downstream Section 1861(ddd) preventive services. Risk factors identified during the IPPE trigger appropriate referrals:

• Alcohol misuse screening positive (AUDIT-C, SASQ during IPPE) → SBIRT counseling under NCD 210.8 (G0442/G0443)
• Tobacco use → Tobacco cessation counseling under NCD 210.4.1 (CPT 99406/99407)
• Depression risk factors identified → Depression screening and follow-up under NCD 210.9 (G0444)
• BMI 30+ → IBT for obesity under NCD 210.12 (G0447/G0473)
• Cardiovascular risk factors → IBT for CVD under NCD 210.11 (G0446)
• Sexual health risk factors → STIs screening and HIBC under NCD 210.10 (G0445)
• Prediabetes → MDPP (G9873-G9890)
• Opioid prescriptions identified → Care coordination including consideration of tapering, alternatives, naloxone (SUPPORT Act 2018 framework)
• Illicit drug use identified → Behavioral health referral; opioid treatment program (OTP) for opioid use disorder

Cancer and Other Screenings

The IPPE written plan of education and counseling identifies appropriate screening tests:

• Colorectal cancer screening (FIT, sigmoidoscopy, colonoscopy, multi-target stool DNA)
• Mammography screening for women
• Cervical cancer screening (Pap test, HPV testing) for women
• Prostate cancer screening (PSA) for men per USPSTF framework
• Lung cancer screening (LDCT) under NCD 210.14 for eligible tobacco users
• Hepatitis C screening under NCD 210.13
• Hepatitis B screening under Medicare preventive services coverage
• HIV screening under NCD 210.7
• Diabetes screening under Section 1861(yy)
• Cardiovascular screening under Section 1861(xx)
• Glaucoma screening under Section 1861(uu) for high-risk populations
• Bone mass measurement under Section 1861(rr)
• Abdominal aortic aneurysm screening for eligible men

The Georgia IPPE Landscape

Newly Medicare-Eligible Georgia Population

Tens of thousands of Georgia residents become newly Medicare-eligible each year, primarily through age-based eligibility at 65 but also through Social Security Disability Insurance (SSDI) pathways and end-stage renal disease pathways. Newly Medicare-eligible beneficiaries enter Medicare through:

• Age-based eligibility at 65: the largest pathway, with most beneficiaries first eligible the month they turn 65.
• SSDI: beneficiaries receiving Social Security Disability Insurance for 24 months become Medicare-eligible.
• End-stage renal disease (ESRD): beneficiaries with permanent kidney failure requiring dialysis or transplantation become Medicare-eligible regardless of age.
• ALS (Lou Gehrig's disease): beneficiaries with ALS become Medicare-eligible the month their SSDI begins.

Major Georgia Primary Care Programs Delivering IPPE

The Georgia primary care delivery network providing IPPE includes:

• Emory Healthcare: comprehensive academic primary care across metropolitan Atlanta
• Wellstar Health System: large primary care network across north and northwest Georgia
• Piedmont Healthcare: primary care network across central and north Georgia
• Northside Hospital: primary care network primarily in metropolitan Atlanta
• Augusta University Health: academic primary care in the Augusta region
• Atrium Health Navicent: primary care in central Georgia (Macon and surrounding region)
• Memorial Health (HCA): primary care in southeast Georgia (Savannah and surrounding region)
• Phoebe Putney Health System: primary care in southwest Georgia (Albany region)

FQHC Network

Georgia's federally qualified health center network provides accessible IPPE delivery on a sliding-fee basis. Major Georgia FQHCs include Mercy Care, Whitefoord, West End Medical, Albany Area Primary Health, Curtis V. Cooper Primary Health, Diversity Health Center, Four Corners Primary Care, and many others.

Rural Georgia Access

Rural Georgia counties face primary care workforce shortages that affect IPPE access. Critical access hospitals (CAHs) and rural health clinics (RHCs) provide primary care infrastructure in many rural counties. Telehealth IPPE provides an important access pathway for rural beneficiaries.

Best Practices for Georgia Medicare IPPE

1. Schedule IPPE early in the 12-month window. Beneficiaries should schedule IPPE within the first three to six months of Medicare Part B enrollment, allowing time for follow-up if issues are identified and avoiding the risk of missing the twelve-month deadline.

2. Identify a primary care provider before IPPE. Beneficiaries who do not have an established primary care relationship should identify a Medicare-enrolled primary care provider before attempting to schedule the IPPE. Continuity of primary care relationship enhances IPPE value.

3. Bring complete records to the IPPE. Bring prior medical records, current medications list (including prescriptions, OTCs, vitamins, supplements), specialist consultation notes, and any prior screening results.

4. Discuss end-of-life planning openly. The IPPE end-of-life planning discussion is a required component. Beneficiaries should approach this discussion as an opportunity to clarify preferences rather than as an uncomfortable topic.

5. Address opioid prescriptions transparently. The SUPPORT Act 2018 requires opioid prescription review during the IPPE. Beneficiaries should bring complete prescription information and engage in discussion about pain management approaches.

6. Address substance use honestly. Alcohol, tobacco, and illicit drug screening during the IPPE provides an opportunity for early intervention. Honest disclosure supports appropriate referrals and treatment.

7. Use the IPPE EKG add-on selectively. The one-time EKG add-on under G0403/G0404/G0405 is available with the IPPE. The EKG may identify atrial fibrillation, prior silent myocardial infarction, or conduction abnormalities, particularly valuable for beneficiaries with cardiovascular risk factors.

8. Plan for follow-up after IPPE. IPPE-identified risk factors and conditions should be followed up appropriately. Schedule follow-up visits for issues requiring further evaluation.

9. Coordinate IPPE with screening tests. Many recommended screening tests can be initiated based on IPPE findings: colorectal cancer screening, mammography, cervical cancer screening, prostate cancer screening, lung cancer screening, diabetes screening, cardiovascular screening, and others.

10. Use IPPE to confirm Medicare coverage knowledge. The IPPE provides an opportunity to learn about Medicare coverage including Part B preventive services, Part D drug coverage considerations, Medigap or Medicare Advantage enrollment, and Medicare Savings Programs for income-eligible beneficiaries.

11. Address chronic condition management at IPPE. Beneficiaries with existing chronic conditions (diabetes, hypertension, COPD, CVD) can discuss management with the new primary care provider, supporting continuity of care during the Medicare transition.

12. Use telehealth IPPE strategically. Telehealth IPPE provides important access for rural beneficiaries. However, some IPPE components (vital signs, visual acuity, EKG) require in-person delivery. Hybrid approaches with telehealth for history components and in-person for examination components may be appropriate.

13. Plan the AWV at 12 months. Beneficiaries completing IPPE should plan for their Initial Annual Wellness Visit at the twelve-month mark, maintaining continuity of preventive care after the IPPE.

14. Document IPPE completion for personal records. Beneficiaries should retain the IPPE written plan of education and counseling and the IPPE summary for their personal records, supporting future preventive care planning and continuity across providers.

Common Issues and How to Resolve Them

1. Beneficiary misses the 12-month enrollment window. Resolution: IPPE eligibility is permanently lost if not completed within first 12 months of Part B enrollment. Beneficiaries who miss the window remain eligible for AWV beginning 12 months after Part B enrollment.

2. Beneficiary confused about IPPE vs AWV. Resolution: Explain that IPPE is once-in-a-lifetime within first 12 months of Part B; AWV is annual beginning at 12 months. They use different HCPCS codes (G0402 vs G0438/G0439).

3. Cost-sharing applied to IPPE claim. Resolution: ACA Section 4104 waives cost-sharing for IPPE. Cost-sharing application is incorrect; contact practice billing office and Medicare at 1-800-MEDICARE if needed.

4. Beneficiary unaware IPPE exists. Resolution: Medicare welcome materials and Medicare.gov reference the IPPE. Education during initial Medicare enrollment process and through GeorgiaCares SHIP counseling can improve IPPE awareness.

5. Required IPPE component not addressed. Resolution: IPPE documentation must reflect all required components including the SUPPORT Act 2018 opioid review and SUD screening additions. Inadequate documentation may result in claim denial.

6. Beneficiary uncomfortable with end-of-life planning discussion. Resolution: End-of-life planning is a required IPPE component but can be addressed sensitively. The discussion does not require advance directive completion at the IPPE; it requires discussion that the beneficiary may build on later.

7. Beneficiary on chronic opioid therapy concerned about IPPE opioid review. Resolution: The SUPPORT Act 2018 opioid review is not about removing chronic pain treatment; it is about coordination, safety, and alternatives. Beneficiaries should engage in discussion transparently.

8. EKG add-on cost or scheduling concerns. Resolution: The one-time EKG add-on under G0403/G0404/G0405 is zero cost-sharing under ACA Section 4104. EKG can be performed during or shortly after the IPPE visit; scheduling depends on practice resources.

9. Beneficiary lacks primary care provider at Medicare entry. Resolution: Use Medicare's provider finder at medicare.gov/care-compare to identify Medicare-enrolled primary care providers in the area. GeorgiaCares SHIP at 1-866-552-4464 can assist.

10. Telehealth IPPE unable to capture EKG. Resolution: The one-time EKG add-on requires in-person delivery. Telehealth IPPE can capture all other components; EKG can be added through in-person visit if elected.

11. Beneficiary in Medicare Advantage plan unsure of IPPE coverage. Resolution: MA plans must cover IPPE at the level of Original Medicare. Contact MA plan customer service for in-network providers and verification.

12. Beneficiary on SSDI or with ESRD entering Medicare under age 65. Resolution: IPPE is available within first 12 months of Medicare Part B enrollment regardless of pathway (age-based, SSDI, ESRD, ALS). Eligibility framework is the same.

13. Beneficiary's preferred provider not Medicare-enrolled. Resolution: IPPE must be furnished by a Medicare-enrolled provider. Beneficiaries may need to establish care with a different Medicare-enrolled provider for IPPE.

14. Family member wants to participate in IPPE. Resolution: Family member participation can support history-taking and care planning, particularly for beneficiaries with cognitive concerns. Beneficiary consent is required.

Worked Examples

Example 1: Fulton County 65-Year-Old Newly Medicare-Eligible: IPPE G0402 Plus EKG G0403 Within First 6 Months

A 65-year-old Fulton County beneficiary becomes Medicare-eligible the month she turns 65. She enrolls in Medicare Part B during her Initial Enrollment Period and schedules her IPPE within the first three months of Part B enrollment with an Emory Healthcare primary care physician.

The IPPE under HCPCS G0402 includes all required components: medical and social history (hypertension on lisinopril for 10 years, family history of CVD with mother MI at 70 and father stroke at 75, current tobacco-free 15 years post-quit, moderate alcohol use 2-3 drinks per week, sedentary lifestyle), potential depression risk factors identification (PHQ-2 0/6, no concerns), functional ability and safety review (independent ADLs and IADLs, no fall history), vital signs (height 5'4", weight 165 lb, BMI 28.3, BP 138/82, visual acuity 20/30 each eye), end-of-life planning discussion (no advance directive currently, plans to complete with attorney), BMI measurement, current opioid prescriptions review (none), SUD screening (alcohol moderate, tobacco quit 15 years, no illicit drug use), and written plan of education and counseling.

The physician orders the one-time IPPE EKG under G0403 (global EKG), which is performed same-day in the office. The EKG returns normal sinus rhythm. The written plan recommends: screening mammography (overdue 3 years), DXA scan (baseline at age 65), Medicare diabetes screening given elevated BMI and family history of CVD, colorectal cancer screening (Cologuard mailed kit or colonoscopy referral), annual subsequent AWV at 12-month mark, and follow-up for hypertension management (BP not at goal). All IPPE and EKG services zero cost-sharing under ACA Section 4104.

Example 2: DeKalb County 65-Year-Old Transition From Employer Coverage — IPPE Within First 12-Month Window

A 65-year-old DeKalb County beneficiary delays Medicare Part B enrollment because he has continued employer-sponsored coverage through his employed wife. He enrolls in Part B six months after his 65th birthday when he retires.

He schedules his IPPE three months after Part B enrollment with a Piedmont Healthcare primary care physician. The IPPE is within his twelve-month eligibility window. The IPPE under G0402 covers all required components. He elects not to have the EKG add-on (his cardiologist did an EKG 8 months ago).

The IPPE identifies risk factors including elevated BMI (BMI 32), prediabetes risk (family history T2DM, sedentary lifestyle), and chronic LBP managed with as-needed acetaminophen. The SUPPORT Act 2018 opioid review confirms no current opioid prescriptions. The written plan recommends MDPP referral (BMI 25+ plus prediabetes evaluation), Medicare diabetes screening (A1C testing ordered), colorectal cancer screening, IBT for obesity counseling under NCD 210.12 (BMI 30+ qualifying), and follow-up for chronic LBP non-pharmacologic management. All IPPE services zero cost-sharing under ACA Section 4104.

Example 3: Cobb County 60-Year-Old SSDI Medicare Entry — IPPE Under Age 65 ESRD-Related

A 60-year-old Cobb County beneficiary entered Medicare three months ago through end-stage renal disease pathway (recent transplantation following 18 months of dialysis). She is now in the first twelve months of Medicare Part B enrollment.

She schedules her IPPE with her transplant nephrologist's partner primary care provider at Wellstar. The IPPE under G0402 addresses all required components within her complex post-transplant clinical picture: medical and social history (transplant 6 months ago, immunosuppression with tacrolimus and mycophenolate, prior dialysis 18 months, hypertension on multiple medications), depression risk identification (PHQ-2 2/6 mild risk factors related to transplant adjustment), functional ability (independent ADLs, some IADL limitations during recovery), vital signs (BMI 26, BP 142/85), end-of-life planning discussion (advance directive previously completed pre-transplant), opioid prescription review (low-dose oxycodone PRN for post-surgical pain, weaning plan), SUD screening (negative), and written plan.

The written plan recommends: continued nephrology and transplant follow-up, behavioral health referral for transplant adjustment counseling, opioid taper coordination, age-appropriate cancer screenings (lower threshold given immunosuppression), depression screening continuing annually, AWV at 12-month mark. The IPPE EKG add-on is elected given her cardiovascular comorbidities. All IPPE and EKG services zero cost-sharing under ACA Section 4104.

Example 4: Worth County 65-Year-Old Rural — IPPE Telehealth Delivery Plus Referrals

A 65-year-old Worth County beneficiary in rural southwest Georgia has primary care through a Phoebe Putney Health System primary care practice in Albany. Travel from Worth County to Albany is approximately 30 miles each way, and she has mobility challenges making travel difficult.

The practice offers telehealth IPPE. She uses a tablet with her daughter's assistance to connect for a video IPPE. The video IPPE captures: medical and social history, depression risk factor identification, functional ability and safety review, BMI calculation (from home scale), blood pressure (from home BP cuff measured during visit), visual acuity screening (using online Snellen tool), end-of-life planning discussion, opioid prescription review, and SUD screening.

Components requiring in-person delivery, including vital signs verification, formal visual acuity examination, and EKG add-on, are scheduled for a separate in-person visit at the practice within four weeks. The written plan recommends in-person follow-up for screening colonoscopy preparation, Medicare diabetes screening (lab work ordered locally), mammography (arranged at Albany imaging center), and AWV at 12-month mark. All IPPE services zero cost-sharing under ACA Section 4104.

Example 5: Bibb County 65-Year-Old IPPE Missed Window — Beneficiary Eligible Only for AWV at 12 Months

A 65-year-old Bibb County beneficiary becomes Medicare-eligible the month he turns 65 and enrolls in Medicare Part B during his Initial Enrollment Period. He is healthy and feels well, and does not schedule the IPPE within the first twelve months. At month thirteen, he visits his primary care physician for routine care.

His primary care physician discusses the IPPE eligibility window. Because he is now beyond the twelve-month enrollment window, IPPE is no longer available. The physician offers the Initial Annual Wellness Visit under G0438 instead, which is available beginning at the twelve-month mark.

The Initial AWV covers many components similar to the IPPE: health risk assessment, routine measurements, cognitive function detection, depression screening, functional ability assessment, history review, medications list, providers list, and Personalized Prevention Plan Service. The AWV does not include the one-time EKG add-on that would have been available with the IPPE.

The beneficiary's prevention plan reflects the AWV framework. While the IPPE opportunity was missed, the AWV provides ongoing annually renewable preventive care coordination. All AWV services zero cost-sharing under ACA Section 4104.

Example 6: Hall County 65-Year-Old IPPE Comprehensive Substance Use Screening Per SUPPORT Act 2018

A 65-year-old Hall County beneficiary newly enrolled in Medicare attends his IPPE four months into his first twelve months of Part B enrollment. He has a history of opioid use disorder in remission (clean and sober for 8 years following a successful treatment program), and currently takes buprenorphine-naloxone maintenance.

The IPPE under HCPCS G0402 includes the SUPPORT Act 2018 substance use disorder screening components in detail: alcohol use (none for 8 years, AUDIT-C 0/12), tobacco use (none for 8 years), illicit drug use (none for 8 years), and review of current opioid prescriptions (buprenorphine-naloxone for OUD maintenance). The opioid prescription review addresses ongoing buprenorphine-naloxone treatment coordination with addiction medicine specialist, naloxone availability at home, and consideration of opioid taper (the beneficiary prefers to continue maintenance based on his treatment team's recommendation).

The written plan recommends: continued addiction medicine follow-up, hepatitis C screening under NCD 210.13 given prior IDU history, HIV screening under NCD 210.7, age-appropriate cancer screenings, IBT for CVD given cardiovascular risk factors, AWV at 12-month mark, and behavioral health continuity. The IPPE EKG add-on is performed. All IPPE services zero cost-sharing under ACA Section 4104.

The IPPE provides an important coordination point for this beneficiary's complex but stable health situation, transitioning his care into the Medicare framework while preserving his ongoing addiction recovery treatment relationships.

Frequently Asked Questions

Georgia Medicare IPPE Contacts

• Medicare: 1-800-MEDICARE (1-800-633-4227) — general Medicare information and IPPE coverage questions
• Palmetto GBA MAC: 1-866-238-9650 — Georgia Medicare Administrative Contractor for Part B claims
• DCH Medicaid Member Services: 1-866-211-0950 — Georgia Medicaid member services
• GeorgiaCares SHIP: 1-866-552-4464 — free Medicare counseling including IPPE scheduling support
• Medicare Rights Center: 1-800-333-4114 — free national Medicare counseling
• Atlanta Legal Aid: 404-377-0701 — legal services for Atlanta-area Medicare beneficiaries
• GA Legal Services: 1-800-498-9469 — legal services for Georgia outside Atlanta
• 211 Georgia: dial 211 — community resource referral
• Eldercare Locator: 1-800-677-1116 — national service connecting seniors with local services
• Georgia DPH: 404-657-2700 — Georgia Department of Public Health
• Social Security Administration: 1-800-772-1213 — Medicare enrollment questions
• CDC-INFO: 1-800-232-4636 — federal CDC information
• Emory Healthcare — Atlanta-area primary care for IPPE
• Wellstar Health System — north Georgia primary care network
• Piedmont Healthcare — central and north Georgia primary care network
• Acentra Health QIO: 1-844-455-8708 — Georgia Quality Improvement Organization
• Medicare.gov — federal Medicare website including IPPE information
• Medicare.gov/care-compare — Medicare provider finder