HCPCS Code G0402: Welcome to Medicare Visit (IPPE)

G0402 is the HCPCS code for the Welcome to Medicare Initial Preventive Physical Exam (IPPE), a one-time visit covered for new Medicare Part B beneficiaries within their first 12 months of enrollment.

This visit focuses on prevention, not treatment. Providers use it to review the patient’s medical and social history, assess risk factors, and guide patients toward appropriate Medicare-covered preventive services. It helps establish a baseline health profile and a clear prevention plan early in coverage.

G0402 is not a comprehensive physical exam and does not include diagnostic tests or lab work as part of the service. Medicare covers only one IPPE per lifetime, and the visit must be completed within the strict 12-month eligibility window to qualify for reimbursement.

This guide covers eligibility rules, required components, billing guidelines, reimbursement, and common compliance risks for HCPCS code G0402.

Official Description of G0402

The official HCPCS description for G0402 is: “Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment.”

This description sets three clear requirements. The visit must be performed face-to-face, limited to patients within their first 12 months of Medicare Part B enrollment, and focused strictly on preventive care.

Providers must use the visit to review health history, assess risks, and establish a prevention plan. It does not include treatment of existing conditions or ongoing care unless those services are separately documented and billed.

What Does the G0402 Visit Include?

The G0402 visit includes nine required components that you must document. According to CMS guidelines, these are:

• Review of the patient’s medical and social history, including past illnesses, surgeries, medications, supplements, family history, diet, physical activity, alcohol/tobacco/illicit drug use, and awareness of Medicare mental health and substance use disorder services.
• Review of potential depression risk factors, using a standardized screening tool.
• Review of functional ability and level of safety, covering hearing, activities of daily living, fall risk, and home safety.
• Physical measurements: height, weight, body mass index (or waist circumference if appropriate), blood pressure, visual acuity screen, and other exam elements based on history.
• End-of-life planning discussion, if the patient agrees, including advance directive information.
• Review of current opioid prescriptions, risk factors for opioid use disorder, pain management options, and referrals if needed.
• Screening for potential substance use disorders and referrals as appropriate.
• Education, counseling, and referrals based on findings.
• Education, counseling, and a brief written plan for other Medicare-covered preventive services, including the once-in-a-lifetime screening electrocardiogram (ECG) if appropriate.

You may perform a screening ECG during the visit using add-on codes G0403, G0404, or G0405.

Who Can Perform the Welcome to Medicare Visit (G0402)?

A physician (MD or DO), physician assistant, nurse practitioner, or certified clinical nurse specialist can perform the G0402 visit. The performing provider must meet Medicare’s qualification rules for the service.

• Scenario 1: A 65-year-old patient enrolls in Medicare Part B on January 1. The primary care office schedules the IPPE in March. The provider reviews history, screens for depression, measures vitals and vision, discusses advance directives, and gives a written plan for future screenings. The practice bills G0402, and the patient receives full coverage.
• Scenario 2: During the IPPE, the provider identifies tobacco use and fall risk in a 67-year-old new beneficiary. The visit includes counseling and referrals to smoking cessation and physical therapy. The provider bills G0402 plus tobacco cessation counseling codes.
• Scenario 3: A patient with an existing opioid prescription for chronic pain attends the IPPE. The provider reviews use disorder risks, discusses non-opioid options, and refers to pain management. Documentation supports G0402 plus any separate E/M if needed.

How to Choose Between G0402, G0438, and G0439

Choose the correct code based on the patient’s Medicare timeline and the type of preventive visit provided.

CMS states you cannot bill G0438 or G0439 within 12 months of billing G0402 for the same patient.

Eligibility, Frequency, and Coverage Rules OF G0402

G0402 eligibility requires the patient to be within the first 12 months after their Medicare Part B effective date. Medicare covers only one IPPE per lifetime. The visit is preventive, so Medicare waives the deductible and coinsurance when the provider accepts assignment. Coverage applies only to new beneficiaries; patients who re-enroll after a gap (for example, after leaving an HMO) do not qualify for a second IPPE.

Coding and Billing Guidelines for G0402

When billing G0402, follow these guidelines for accurate reimbursement:

Base IPPE Service: Bill G0402 for the face-to-face preventive visit that includes all nine required components.

Screening ECG Add-Ons: If you perform the screening electrocardiogram during the visit, add one of these codes:

• G0403: ECG with interpretation and report
• G0404: ECG tracing only
• G0405: ECG interpretation and report only

Same-Day E/M Services: When a medically necessary evaluation and management service occurs on the same day as the IPPE (addressing acute or chronic problems unrelated to the preventive visit), report the appropriate E/M code (99202-99215) with modifier 25 attached to indicate it’s a significant, separately identifiable service.

Diagnosis Coding: While no specific diagnosis code is mandated for G0402, use codes consistent with the patient’s history and examination findings. Common choices include Z00.00 (encounter for general adult medical examination without abnormal findings) or Z00.01 (encounter for general adult medical examination with abnormal findings).

Documentation Requirements For G0402

Thorough documentation protects against audits and ensures compliance. Your medical record must demonstrate completion of all nine required IPPE components:

• Record specific patient responses to history questions, not just checkmarks
• Document which standardized screening tool was used for depression assessment, and the results
• Record actual measurement values (height in inches/cm, weight in pounds/kg, BMI calculation, blood pressure readings, visual acuity results)
• Note whether the patient agreed to the end-of-life planning discussion and document the content
• Describe counseling provided and referrals made with sufficient detail
• Include the written prevention plan in the medical record or clearly reference its provision to the patient
• Document time spent if billing additional time-based services

Many practices use IPPE-specific templates or checklists to ensure no component is overlooked. These tools improve both compliance and efficiency.

Reimbursement Rate Of G0402 (2026)

The national average Medicare reimbursement rate for G0402 is $174.69 in a non-facility setting (Physician’s office), and $114.23 in a facility setting (Hospital outpatient department)

These rates are adjusted based on geographic factors using the Medicare Physician Fee Schedule, so actual payment may vary by location. 

The place of service also affects reimbursement, with non-facility settings typically receiving higher payments due to covering practice expenses.

When the provider accepts Medicare assignment, the visit is fully covered as a preventive service, and the patient pays nothing out of pocket.

Telehealth Coverage For G0402

G0402 is defined as a face-to-face service, which means you must perform the Welcome to Medicare visit in person. Medicare does not recognize this visit as eligible for telehealth under standard billing rules, so virtual delivery does not qualify for reimbursement.

If you submit G0402 as a telehealth service, Medicare will deny the claim because it does not meet the in-person requirement outlined in the code descriptor. This applies regardless of the platform used, including video visits.

The same limitation extends to the optional ECG services associated with the IPPE, including G0403, G0404, and G0405. When performed as part of the IPPE, these services must also be completed in person to be eligible for payment.

To avoid denials, schedule G0402 visits as in-office encounters and clearly document that the service was delivered face to face.

Common Denials, Mistakes, and Compliance Risks For G0402

Claims for G0402 are most often denied when the visit falls outside the 12-month Part B eligibility window, when the patient has already received an IPPE, or when required documentation is incomplete. 

The most frequent issue is timing. If the patient is beyond the 12-month window, Medicare will deny the claim. In those cases, bill the appropriate Annual Wellness Visit instead using G0438 or G0439.

Documentation gaps also trigger denials and audits. Missing elements such as the visual acuity screen, a documented prevention plan, or patient consent for end-of-life planning increase compliance risk. 

Billing G0402 without clearly recording all required components can lead to recoupments during audits.

To reduce risk, verify the patient’s Part B start date before scheduling, confirm no prior IPPE has been billed, and use a structured checklist to capture every required element. When you provide a separate, medically necessary E/M service on the same day, apply modifier 25 correctly with proper documentation.

Strong compliance depends on clear, real-time documentation and consistent staff training, especially around the strict one-time, 12-month eligibility rule.

Final Words

G0402 gives providers a one-time chance to establish a strong preventive care baseline for new Medicare patients. When you follow the 12-month eligibility rule, complete all required components, and document each element clearly, the visit becomes both clinically valuable and financially secure. 

Missed steps, like timing or documentation gaps, are the most common reasons for denials and audits. Using structured templates, verifying Part B start dates, and confirming no prior IPPE helps reduce risk. When performed correctly, this visit not only ensures full reimbursement but also builds a long-term prevention plan that improves patient outcomes and strengthens continuity of care.