If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized prevention plan based on your current health and risk factors.

This includes:

   •  Health risk assessment (your doctor or health professional will ask you to answer some questions before or during your visit, which is called a health risk assessment. your responses to the questions will help you and your health professional get the most from your yearly "wellness" visit.);

   •  Review of medical and family history;

   •  Develop or update a list of current providers and prescriptions;

   •  Height, weight, blood pressure, and other routine measurements;

   •  Detection of any cognitive impairment;

   •  Personalized health advice;

   •  A list of risk factors and treatment options for you;

   •  A screening schedule (like a checklist) for appropriate preventive services;

Who Is Covered

All Medicare beneficiaries:

   • Who are not within 12 months after the effective date of their first Medicare Part B coverage period; and

   • Who have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months

HCPCS/CPT Codes

G0402 - Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

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

ICD-10-CM Codes

See the CMS ICD-10 webpage for individual Change Requests (CRs) and coding translations for ICD-10 and contact your Medicare Administrative Contractor (MAC) for guidance.

Frequency

Once in a lifetime

Note: Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

Medicare Beneficiary Pays

G0402:

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

G0403, G0404, and G0405:

   • Copayment applies

   • Coinsurance applies

   • Deductible applies

References