Coverage Issues
Q. Relating to the Initial Preventive Physical Exam (a preventive service available as of January 1, 2005), is there a specific diagnosis that must be used to identify it as the IPPE?
A. No. There is no diagnosis specified for the IPPE. The identifiers are the appropriate “G” codes (depending on the services rendered):
• G0344 - Initial Preventive Physical Examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment
• G0366 – Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the Initial Preventive Physical Examination
• G0367 – Tracing only, without interpretation and report, performed as a component of the Initial Preventive Physical Examination
• G0368 – Interpretation and report only, performed as a component of the Initial Preventive Physical Examination
Note: While there are no specific diagnosis requirements for billing the IPPE, CMS 1500 billing instructions state that a diagnosis must be entered on the claim or it will deny. Therefore, a claim still requires a diagnosis that reflects signs or symptoms indicating the reason for the encounter.
(Last Modified 9/27/07)
Source: CMS IOM Pub 100-04 - Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.1;
Chapter 18, Section 80; Chapter 26, Section 10.4
Chapter 18, Section 80; Chapter 26, Section 10.4
