Coding & Billing

G0402: the Welcome to Medicare visit (IPPE)

~9 min readBy Pelica Health teamPublished August 28, 2026Updated August 28, 2026Reviewed by Catherine Zhao

Short answer

G0402 is the HCPCS code for the Initial Preventive Physical Examination, the visit Medicare calls the Welcome to Medicare visit. Medicare pays for one per lifetime, and only when the visit happens in the first 12 months after Part B coverage starts. Miss that window and the benefit is gone: the patient's first covered wellness visit becomes G0438, the initial Annual Wellness Visit. The IPPE is not a physical exam, and it is not the AWV.

What G0402 is

G0402 is the HCPCS code for the Initial Preventive Physical Examination, the visit Medicare markets to beneficiaries as the Welcome to Medicare visit. The official descriptor reads: "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment."

Two limits define it. Medicare pays for one IPPE per lifetime, and only when the visit happens in the first 12 months after Part B coverage starts. 42 CFR 410.16 defines an eligible beneficiary as someone who receives the exam not more than one year after the effective date of their first Medicare Part B coverage period. Outside that window there is no IPPE benefit, ever.

Despite the name, it is not a physical. The IPPE is a structured review of history, risk, and function with a short list of specified measurements, ending in a written plan for the screenings the patient is due.

12 months

Window after Part B starts. Miss it and the benefit is gone permanently

1 per lifetime

Medicare pays for exactly one IPPE per beneficiary

$174.69

2026 national non-facility payment for G0402, with no patient cost sharing

G0402 vs G0438 vs G0439 vs an annual physical

This is where the money gets lost. Four different visits get called "the Medicare wellness visit" in a front-office conversation, and only three of them are covered.

	G0402 (IPPE)	G0438 (initial AWV)	G0439 (subsequent AWV)	Annual physical
When it can be billed	Only in the first 12 months of Part B	After 12 months of Part B, and not within 12 months of a G0402	12 months after the last AWV	Any time
How often	Once per lifetime	Once per lifetime	Once per 12 months	As often as the patient wants
What it is	History, risk and function review, limited measurements, written screening plan	Health risk assessment plus a personalized prevention plan	Review and update of that plan	Head-to-toe examination
Hands-on exam	Specified measurements only: height, weight, BMI, blood pressure, balance, gait, visual acuity	Height, weight, BMI, blood pressure	Weight and blood pressure	Full physical
Medicare covers it	Yes	Yes	Yes	No, never
Patient pays	Nothing, when the provider accepts assignment	Nothing	Nothing	The full charge
2026 national non-facility payment	$174.69	$174.35	$137.61	Not applicable
On the CY2026 telehealth list	No	Yes	Yes	Not applicable

Two rules from that table do most of the denying. CMS says not to bill G0438 or G0439 within 12 months of billing G0402 for the same patient, and denies those claims with a message that the patient has reached the benefit maximum for the period. And Medicare has never covered a routine annual physical, so the comprehensive preventive medicine codes 99381 through 99397 are not a fallback when the IPPE window has closed.

The telehealth row is a live 2026 difference. G0438 and G0439 appear on the CY2026 Medicare Telehealth Services List. G0402 does not, so the Welcome to Medicare visit has to happen face to face.

The nine components of an IPPE

CMS lists these on its Initial Preventive Physical Exam page, and the underlying detail is at 42 CFR 410.16. All nine belong in the note.

Medical and social history. Past medical and surgical history, current medications and supplements, family history, diet, physical activity, social activities and engagement, and alcohol, tobacco, and illegal drug use.
Depression risk factors, reviewed with a standardized screening tool recognized by a national professional medical organization.
Functional ability and safety. At minimum: activities of daily living, fall risk, hearing impairment, and home and community safety, including driving where appropriate.
The exam. Height, weight, body mass index or waist circumference, blood pressure, balance, gait, and a visual acuity screen, plus anything else clinically indicated.
End-of-life planning, upon the patient's agreement. Verbal or written information about advance directives and whether the practitioner will follow one.
Review of current opioid prescriptions. For a patient on opioids: risk factors for opioid use disorder, pain severity and current treatment plan, information on non-opioid options, and referral as appropriate.
Screening for potential substance use disorders, with referral as appropriate. A screening tool is allowed but not required.
Education, counseling, and referral based on what the previous components found.
A brief written plan, such as a checklist, covering the once-in-a-lifetime screening electrocardiogram and the other preventive services the patient is due.

The screening EKG codes

The EKG is not part of the IPPE. It is a separate, once-in-a-lifetime screening the IPPE can refer to, billed with G0403 for the complete study, G0404 for the tracing only, or G0405 for the interpretation and report only. The 2026 national payments are roughly $15.36, $7.01, and $8.35.

Cost sharing splits here, and it surprises patients. The Part B deductible does not apply to G0402 and the patient pays nothing for the visit when the provider accepts assignment. The screening EKG is not treated the same way: coinsurance and the deductible both apply to G0403, G0404, and G0405. A patient told the Welcome to Medicare visit was free, who then gets a bill for the EKG, calls the practice.

Who can furnish it

Part B covers an IPPE performed by a physician, meaning a doctor of medicine or osteopathy, or a qualified non-physician practitioner: a physician assistant, nurse practitioner, or certified clinical nurse specialist.

That list is shorter than the AWV list, and the difference gets missed. CMS also allows an AWV to be performed by a medical professional such as a health educator, registered dietitian, or nutrition professional, or by a team of medical professionals under the direct supervision of a physician. The IPPE has no equivalent provision. If a health educator ran the visit, it is not a billable G0402.

Billing an E/M with the same visit

When the IPPE turns up a problem that needs work in the moment, you can bill for that separately. CMS allows a significant, separately identifiable, medically necessary E/M service on the same day: report 99202 through 99205 or 99211 through 99215 with modifier 25. The E/M portion has to be medically necessary and reasonable to treat an illness or injury, and it carries normal cost sharing.

Report a diagnosis code on the IPPE claim. CMS does not require a specific one, so use any code consistent with the exam.

Why G0402 gets denied

CMS does not publish a denial ranking for G0402. Each row below is a rule that makes the claim unpayable when it is missed.

What went wrong	Why the claim fails
Date of service falls outside the first 12 months of Part B	42 CFR 410.16 limits the benefit to an eligible beneficiary, defined by that window
The patient already had an IPPE	One per lifetime
G0438 or G0439 billed within 12 months of the G0402	CMS denies with a benefit-maximum-reached message
Billed as 99381 through 99397	Medicare does not cover routine physicals, and CMS says not to use those codes for services covered by G0402, G0438, or G0439
The patient was charged a copay or the deductible was applied	Neither applies to G0402 when the provider accepts assignment
Required components missing from the note	The IPPE is defined by its nine components, not by time
Furnished by a health educator or dietitian	Only physicians and qualified non-physician practitioners can furnish an IPPE, unlike the AWV
Delivered by telehealth	G0402 is not on the CY2026 Medicare Telehealth Services List
Screening EKG billed without an IPPE referral	G0403 through G0405 are covered as a referral from the IPPE, once in a lifetime

What to do when the window has closed

Nothing recovers a missed IPPE. What you can do is stop treating it as the only option. A patient at month 13 of Part B is eligible for G0438, the initial Annual Wellness Visit, which pays $174.35 and covers most of the same ground through a health risk assessment and a personalized prevention plan. 42 CFR 410.15 defines the eligible beneficiary for an AWV as someone no longer within 12 months after their first Part B coverage period who has not had an IPPE or AWV in the past 12 months.

The IPPE also does double duty that teams forget. It counts as a qualifying initiating visit for chronic care management and for APCM, as long as the service is discussed during the visit. A practice that runs IPPEs and never mentions monthly care management is leaving the enrollment conversation for a later appointment that often does not happen.

How Pelica catches the 12-month window

The reason IPPEs get missed is not clinical. It is that the deadline lives in a field nobody watches. Part B effective date sits in the plan's enrollment file, the window is 365 days long, and by the time a new member surfaces on a care gap report the clock has usually been running for months.

Pelica reads enrollment alongside claims, EHR, pharmacy, lab, and ADT feeds, and puts every newly eligible member on a worklist with the IPPE deadline attached, ordered by how little time is left. The outreach runs from there, and the visit lands with the prep already done. Customers run this across 350,000+ members, and go live in about two weeks.

Related terms

AWV CPT codes covers G0438 and G0439, the visits that take over once the IPPE window closes. Annual Wellness Visit explains what the AWV actually requires. The Annual Wellness Visit checklist is the printable version for the exam room, and CCM CPT codes covers the monthly service an IPPE can initiate.

Sources

Frequently asked questions

Common questions about G0402, the 12-month window, how it differs from the Annual Wellness Visit, and 2026 payment.

What is G0402?

G0402 is the HCPCS code for the Initial Preventive Physical Examination, also called the Welcome to Medicare visit. Its descriptor reads: initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment. Medicare pays for one per beneficiary per lifetime.

What is the difference between G0402 and G0438?

G0402 is the Initial Preventive Physical Examination, billable only in the first 12 months after Part B coverage starts. G0438 is the initial Annual Wellness Visit, billable after the patient has had Part B for more than 12 months and not within 12 months of a G0402. The IPPE is a structured review of history, risk and function with a short list of measurements. The AWV is built around a health risk assessment and a personalized prevention plan. Both are once per lifetime, and a patient can receive both.

How long does a patient have to get the Welcome to Medicare visit?

Twelve months from the effective date of their first Medicare Part B coverage period. 42 CFR 410.16 defines an eligible beneficiary as someone who receives the initial preventive examination not more than one year after that date. Once the window closes there is no way to bill an IPPE for that patient, and the next covered option is G0438.

Is the Welcome to Medicare visit an annual physical?

No. Medicare has never covered a routine annual physical. The IPPE has no head-to-toe examination; the only required measurements are height, weight, body mass index or waist circumference, blood pressure, balance, gait, and a visual acuity screen. CMS says not to use the comprehensive preventive medicine codes 99381 through 99397 to bill services covered by G0402, G0438, or G0439.

How much does Medicare pay for G0402 in 2026?

About $174.69 in the non-facility setting and $114.23 in the facility setting, calculated from the CMS CY2026 Physician Fee Schedule Relative Value File, January release, at the standard conversion factor of $33.4009. Actual payment varies by locality because of the geographic practice cost indices.

Does the patient pay anything for the Welcome to Medicare visit?

Nothing for the visit itself when the provider accepts assignment, and the Part B deductible does not apply. The screening electrocardiogram is treated differently: coinsurance and the Part B deductible both apply to G0403, G0404, and G0405. Additional tests or services performed at the same visit that are not part of the preventive benefit also carry normal cost sharing.

Can G0402 be done by telehealth?

No. G0402 does not appear on the CY2026 Medicare Telehealth Services List, so the IPPE has to be furnished face to face. G0438 and G0439, the Annual Wellness Visit codes, are on that list and can be furnished by telehealth.

Why do G0402 claims get denied?

The most common causes are a date of service outside the first 12 months of Part B, a patient who already received an IPPE, an AWV billed within 12 months of the G0402, and the visit billed with a routine physical code instead of G0402. Others include missing required components in the note, a provider type that cannot furnish an IPPE, delivery by telehealth, and a screening EKG billed without an IPPE referral.

The 12-month IPPE window closes in a field nobody is watching.

Pelica reads enrollment alongside claims, EHR, pharmacy, lab and ADT, and puts every newly eligible member on a worklist with the deadline attached, ordered by how little time is left. Live in about two weeks across 350,000+ members.

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