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What is the Welcome to Medicare checkup?
| You can get one free Welcome to Medicare checkup anytime during the first 12 months after you enroll in Medicare Part B , which is the part of Medicare that covers doctor visits and outpatient services. This checkup is not a comprehensive physical exam but is an opportunity for your doctor to assess your health and provide a plan of future care.
The Welcome to Medicare checkup is optional, but it serves as a baseline for monitoring your health during the annual wellness visits that Medicare will pay for in subsequent years. You do not need this checkup to qualify for later annual wellness visits, but Medicare won’t pay for a wellness visit during your first 12 months in Part B.
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What happens at the Welcome to Medicare checkup?
During the exam you can expect your doctor to do the following:
- Record your vital information, including blood pressure, height and weight.
- Calculate your Body Mass Index (BMI).
- Review your health history — your own and that of your family.
- Determine your ability to function independently and your level of safety, such as how well you perform activities of daily living and your risk of falls.
- Assess your potential for depression.
- Check for risk factors that could indicate future serious illnesses.
- Provide a simple vision test.
- Recommend screenings, shots and other preventive services in writing that you may need to stay healthy. Many of these, such as mammograms and vaccinations, may be free under Medicare.
- Offer to talk about advance directives . A health care proxy lets you designate someone else to make medical decisions on your behalf if you can’t, and a living will specifies your preferences for medical treatment at the end of your life.
How can I prepare for my Welcome to Medicare visit?
To make the most of this appointment, you should gather the following information and records in advance:
- Your family medical history Learn as much as you can about your blood relatives’ health history. Any information you can give your doctor can help determine if you are at risk for inherited diseases.
- Your personal medical records That includes providing immunization records if you’re seeing a new doctor.
- Your prescription medications Along with listing the names of your drugs, include dosage, how often you take each medication and why.
How much will I pay for a Welcome to Medicare checkup?
You’ll have no deductible or copayment for the Welcome to Medicare checkup if you meet the following conditions:
If you’re enrolled in original Medicare, you need to go to a doctor who accepts “assignment,” meaning that the physician accepts the Medicare-approved amount as full compensation.
If you’re enrolled in a Medicare Advantage plan that has a provider network, such as an HMO or PPO , you may need to go to a doctor in the plan’s provider network.
Keep in mind
Even though you won’t have to pay for this checkup, the doctor could order other tests or procedures for which you may have to cover deductibles and copayments out of pocket.
Updated June 22, 2022
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Medicare Wellness Visits Back to MLN Print November 2023 Updates
What’s Changed?
- Added information about monthly chronic pain management and treatment services
- Added information about checking for cognitive impairment during annual wellness visits
- Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits
Quick Start
The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.
Medicare Physical Exam Coverage
Initial Preventive Physical Exam (IPPE)
Review of medical and social health history and preventive services education.
✔ New Medicare patients within 12 months of starting Part B coverage
✔ Patients pay nothing (if provider accepts assignment)
Annual Wellness Visit (AWV)
Visit to develop or update a personalized prevention plan and perform a health risk assessment.
✔ Covered once every 12 months
Routine Physical Exam
Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.
✘ Medicare doesn’t cover a routine physical
✘ Patients pay 100% out-of-pocket
Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :
- Health Equity Technical Assistance Program
- Disparities Impact Statement
Communication Avoids Confusion
As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.
Initial Preventive Physical Exam
The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.
1. Review the patient’s medical and social history
At a minimum, collect this information:
- Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
- Current medications, supplements, and other substances the person may be using
- Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
- Physical activities
- Social activities and engagement
- Alcohol, tobacco, and illegal drug use history
Learn information about Medicare’s substance use disorder (SUD) services coverage .
2. Review the patient’s potential depression risk factors
Depression risk factors include:
- Current or past experiences with depression
- Other mood disorders
Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.
3. Review the patient’s functional ability and safety level
Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:
- Ability to perform activities of daily living (ADLs)
- Hearing impairment
- Home and community safety, including driving when appropriate
Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.
- Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
- Visual acuity screen
- Other factors deemed appropriate based on medical and social history and current clinical standards
5. End-of-life planning, upon patient agreement
End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:
- Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
- If you agree to follow their advance directive
- This includes psychiatric advance directives
6. Review current opioid prescriptions
For a patient with a current opioid prescription:
- Review any potential opioid use disorder (OUD) risk factors
- Evaluate their pain severity and current treatment plan
- Provide information about non-opiod treatment options
- Refer to a specialist, as appropriate
The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .
7. Screen for potential SUDs
Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .
8. Educate, counsel, and refer based on previous components
Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.
9. Educate, counsel, and refer for other preventive services
Include a brief written plan, like a checklist, for the patient to get:
- A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
- Appropriate screenings and other covered preventive services
Use these HCPCS codes to file IPPE and ECG screening claims:
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv
* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.
Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.
Part B covers an IPPE when performed by a:
- Physician (doctor of medicine or osteopathy)
- Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)
When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.
CPT only copyright 2022 American Medical Association. All rights reserved.
IPPE Resources
- 42 CFR 410.16
- Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
- Section 80 of the Medicare Claims Processing Manual, Chapter 18
- U.S. Preventive Services Task Force Recommendations
No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.
No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.
No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).
A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.
We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .
Annual Wellness Visit Health Risk Assessment
The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.
Perform an HRA
- You or the patient can update the HRA before or during the AWV
- Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
- Demographic data
- Health status self-assessment
- Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
- Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
- Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances
1. Establish the patient’s medical and family history
At a minimum, document:
- Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
- Use of, or exposure to, medications, supplements, and other substances the person may be using
2. Establish a current providers and suppliers list
Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.
- Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
- Other routine measurements deemed appropriate based on medical and family history
4. Detect any cognitive impairments the patient may have
Check for cognitive impairment as part of the first AWV.
Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.
5. Review the patient’s potential depression risk factors
6. Review the patient’s functional ability and level of safety
- Ability to perform ADLs
7. Establish an appropriate patient written screening schedule
Base the written screening schedule on the:
- Checklist for the next 5–10 years
- United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
- Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover
8. Establish the patient’s list of risk factors and conditions
- A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
- Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
- IPPE risk factors or identified conditions
- Treatment options and associated risks and benefits
9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs
Include referrals to educational and counseling services or programs aimed at:
- Fall prevention
- Physical activity
- Tobacco-use cessation
- Social engagement
- Weight loss
10. Provide advance care planning (ACP) services at the patient’s discretion
ACP is a discussion between you and the patient about:
- Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
- Future care decisions they might need or want to make
- How they can let others know about their care preferences
- Caregiver identification
- Advance directive elements, which may involve completing standard forms
Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.
We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.
11. Review current opioid prescriptions
- Review any potential OUD risk factors
- Provide information about non-opioid treatment options
12. Screen for potential SUDs
Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .
13. Social Determinants of Health (SDOH) Risk Assessment
Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.
1. Review and update the HRA
2. Update the patient’s medical and family history
At a minimum, document updates to:
3. Update current providers and suppliers list
Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.
- Weight (or waist circumference, if appropriate) and blood pressure
5. Detect any cognitive impairments patients may have
Check for cognitive impairment as part of the subsequent AWV.
6. Update the patient’s written screening schedule
Base written screening schedule on the:
7. Update the patient’s list of risk factors and conditions
- Mental health conditions, including depression, substance use disorders , and cognitive impairments
- Risk factors or identified conditions
8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs
9. Provide advance care planning (ACP) services at the patient’s discretion
10. Review current opioid prescriptions
11. Screen for potential substance use disorders (SUDs)
12. Social Determinants of Health (SDOH) Risk Assessment
Preparing Eligible Patients for their AWV
Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:
- Medical records, including immunization records
- Detailed family health history
- Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
- Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists
Use these HCPCS codes to file AWV claims:
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.
Part B covers an AWV if performed by a:
- Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician
When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.
You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.
Medicare telehealth includes HCPCS codes G0438 and G0439.
ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.
Use these CPT codes to file ACP claims as an optional AWV element:
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.
We waive both the Part B ACP coinsurance and deductible when it’s:
- Provided on the same day as the covered AWV
- Provided by the same provider as the covered AWV
- Billed with modifier 33 (Preventive Service)
- Billed on the same claim as the AWV
We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .
We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.
SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.
Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:
Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes
Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.
The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:
We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.
If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.
AWV Resources
- 42 CFR 410.15
- Section 140 of the Medicare Claims Processing Manual, Chapter 18
No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.
No. We waive the coinsurance, copayment, and Part B deductible for the AWV.
We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.
Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.
You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.
Know the Differences
An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .
- We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
- We pay IPPE costs if the provider accepts assignment
An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.
- We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
- We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
- We pay AWV costs if the provider accepts assignment
A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.
- We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
- Patients pay 100% out of pocket
View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure .
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).
CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
New to Medicare? Schedule your "Welcome to Medicare" visit
Published by Medicare Made Clear®
If you’re new to Medicare, you get a free “Welcome to Medicare” visit. You may be wondering what the “Welcome to Medicare” visit is all about and why it’s worth scheduling.
What is the “Welcome to Medicare” visit?
The "Welcome to Medicare" visit is a one-time-only preventative health care visit covered by Medicare Part B. It is not the same as a routine physical exam or annual Medicare Wellness visit . The Welcome to Medicare visit is an introduction to Medicare and focuses on disease prevention and detection to help beneficiaries live a healthier life.
You have twelve months from the date of your initial enrollment into Medicare Part B to complete the visit 1 .
What do I pay for the “Welcome to Medicare” visit?
You pay nothing for this visit if the doctor or other health care professional you see for it accepts Medicare, and the Part B deductible doesn’t apply.
However, if your doctor performs additional tests or services during this visit that are not covered under the preventative benefits, you may have to pay a coinsurance. In this case, the Part B deductible will also apply.
What your “Welcome to Medicare” visit covers
During your “Welcome to Medicare” visit, you and your doctor will discuss disease education and prevention. Your doctor will also review your medical and health history, such as:
- Past medical/surgical history, such as illness, hospital stays, operations, allergies, and injuries
- Current medications and supplements, including over-the-counter vitamins
- Depression and safety screenings
- Family health history
- History of alcohol, tobacco, and illicit drug use
- Diet and exercise
The visit will also include:
- Measurements for your height, weight, blood pressure and body mass index (BMI)
- A simple vision test
- Review of your risks for depression
- A written plan for screenings, shots and other preventive services you may need
- In some cases, a discussion about creating an advance directive
Remember, if diagnostic tests or other services are performed that are not covered by the "Welcome to Medicare" visit, you may be responsible for copays and coinsurance.
Prepare for your “Welcome to Medicare” visit
Make the most of your “Welcome to Medicare” visit by compiling some important information and reference documents beforehand. Gather and take the following items with you to your visit: Medical records, including immunization records; a detailed family health history; and a full list of medications and supplements, including calcium and vitamins, and how often and how much of each is taken.
About Medicare Made Clear
Medicare Made Clear brought to you by UnitedHealthcare provides Medicare education so you can make informed decisions about your health and Medicare coverage.
- Introduction to Medicare
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Welcome to Medicare Preventive Visit
Written by: Bryan Strickland
Reviewed by: Malinda Cannon, Licensed Insurance Agent
Key Takeaways
You qualify for a “Welcome to Medicare” health assessment during the first 12 months you are enrolled in Part B Medicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. of Original Medicare.
The visit, provided at no cost to you, sets a baseline for your health plan moving forward.
After the first year, the “Welcome to Medicare” results can be revisited at your annual wellness visit. Both are covered by Medicare but shouldn’t be confused with a “head-to-toe” annual physical, which is not covered.
Original Medicare Part B covers all the costs of one “Welcome to Medicare” preventive visit during the first 12 months you have Part B. This visit with a Medicare-approved doctor sets the baseline for your treatment moving forward.
You forfeit your opportunity for a “Welcome to Medicare” visit after 12 months on Part B, but you will then be eligible for a similar annual wellness visit once every 12 months at no cost to you.
When you call to schedule an appointment, you must make sure your doctor knows you’re specifically scheduling your “Welcome to Medicare” visit (or your annual wellness visit in subsequent years). It should not be confused with an annual physical, which Medicare does not cover.
Medicare Advantage plans, which replace Original Medicare and offer at least the same coverage as Parts A and B, also cover a “Welcome to Medicare” visit. Also, many Medicare Advantage plans cover other preventive services not covered by Original Medicare.
What Medicare coverage is right for my specific situation?
What is Welcome to Medicare Preventive Visit?
The “Welcome to Medicare” preventive visit is not a comprehensive exam, but rather an assessment of your health by your doctor. At the end of your visit, your doctor will provide a plan for future care after establishing your health baseline. [i]
If treatment goes beyond what is covered by the “Welcome to Medicare” preventive visit, you may be financially responsible for additional services. You can receive treatment at the visit to avoid a return visit, but be sure you understand the potential financial impact.
What Happens at a Welcome to Medicare visit?
Your “Welcome to Medicare” preventive visit is an opportunity to assess your health and discuss ways to improve or maintain your health. After reviewing your medical and social history, you will receive helpful information from your doctor about your health and preventive services, including:
- Covered annual screenings and vaccines, if needed, and referrals for other care.
- Height, weight and blood pressure measurements.
- A calculation of your body mass index.
- A simple vision test.
- Your risk for depression and your level of safety.
- Discussion about creating advance directives.
- A written plan letting you know which screenings, shots and other preventive services you need .
To get the most out of your appointment, you should plan ahead and be prepared. Have current prescriptions and your family history of significant health concerns ready for discussion. If you’re seeing a new doctor, this is essential information to include in your health plan.
Have questions about your Medicare coverage?
What is the Difference Between Welcome to Medicare and Annual Wellness Visit?
While the visits are similar, the “Welcome to Medicare” visit is only available during your first 12 months of Part B coverage and sets the baseline for health assessments going forward.
After your “Welcome to Medicare” preventive visit, annual wellness visits determine progress or decline in your health based on the health plan from your previous visit.
Both visits assess improvement or decline in your health and determine a care plan tailored to your needs of maintaining or improving your health. Medicare covers one “Welcome to Medicare” visit in the first 12 months you have Part B. After you have Part B for at least 12 months, Medicare covers one annual wellness visit each year. Your annual wellness visit may include a “Health Risk Assessment” similar to the “Welcome to Medicare” visit. [i]
Is the Welcome to Medicare Visit Mandatory?
A “Welcome to Medicare” visit is not necessary to maintain your Part B coverage, but it can be a valuable tool in your health journey and is offered at no cost in the first 12 months you are enrolled in Medicare Part B.
Find a local Medicare plan that fits your needs.
“Welcome to Medicare” preventive visit TRUSTED & VERIFIED medicare.gov . medicare.gov.
Yearly “Wellness” visits . medicare.gov.
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Doctor Visits
Get Your Medicare Wellness Visit Every Year
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If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.
What happens during a yearly wellness visit?
First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.
During your visit, the doctor or nurse will:
- Go over your health risk assessment with you
- Measure your height and weight and check your blood pressure
- Ask about your health history and conditions that run in your family
- Ask about other doctors you see and any medicines you take
- Give advice to help you prevent disease, improve your health, and stay well
- Look for any changes in your ability to think, learn, or remember
- Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed
If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist.
Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick.
Learn more about yearly wellness visits .
Plan Your Visit
When can i go for a yearly wellness visit.
You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.
Do I need to have a “Welcome to Medicare” visit first?
You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.
If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit.
Learn more about the “Welcome to Medicare” visit .
What about cost?
With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.
If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.
Who Can Get Medicare?
Medicare is a federal health insurance program. You may be able to get Medicare if you:
- Are age 65 or older
- Are under age 65 and have a disability
- Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
- Have permanent kidney failure (called end-stage renal disease)
You must be living in the United States legally for at least 5 years to qualify for Medicare. Answer these questions to find out when you can sign up for Medicare .
Make an Appointment
Take these steps to help you get the most out of your Medicare yearly wellness visit.
Schedule your Medicare yearly wellness visit.
Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.
If you're looking for a new doctor, check out these tips on choosing a doctor you can trust .
To find a doctor who accepts Medicare:
- Search for a doctor on the Medicare website
- Call 1-800-MEDICARE (1-800-633-4227)
- If you use a TTY, call Medicare at 1-877-486-2048
Gather important information.
Take any medical records or information you have to the appointment. Make sure you have important information like:
- The name and phone number of a friend or relative to call if there’s an emergency
- Dates and results of checkups and screening tests
- A list of vaccines (shots) you’ve gotten and the dates you got them
- Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
- Phone numbers and addresses of other places you go to for health care, including your pharmacy
Make a list of any important changes in your life or health.
Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:
- Losing your job
- A death in the family
- A serious illness or injury
- A change in your living situation
Know your family health history.
Your family's health history is an important part of your personal health record. Use this family health history tool to keep track of conditions that run in your family. Take this information to your yearly wellness visit.
Ask Questions
Make a list of questions you want to ask the doctor..
This visit is a great time to ask the doctor or nurse any questions about:
- A health condition
- Changes in sleeping or eating habits
- Pain or discomfort
- Prescription medicines, over-the-counter medicines, or supplements
Some important questions include:
- Do I need to get any vaccines to protect my health?
- How can I get more physical activity?
- Am I at a healthy weight?
- Do I need to make any changes to my eating habits?
Use this question builder tool to make a list of things to ask your doctor or nurse.
It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.
What to Expect
Know what to expect at your visit..
The doctor or nurse will ask you questions about your health and safety, like:
- Do you have stairs in your home?
- What do you do to stay active?
- Have you lost interest in doing things you usually enjoy?
- Do you have a hard time hearing people on the phone?
- What medicines, vitamins, or supplements do you take regularly?
The doctor or nurse will also do things like:
- Measure your height and weight
- Check your blood pressure
- Ask about your medical and family history
Make a wellness plan with your doctor.
During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.
Your plan may include:
- Getting important screenings for cancer or other diseases
- Making healthy changes, like getting more physical activity
Follow up after your visit.
During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.
If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.
Add any new health information to your personal health documents.
Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.
Medicare offers an online tool called MyMedicare to help you track your personal health information and Medicare claims. If you have your Medicare number, you can sign up for your MyMedicare account now .
Healthy Habits
Take care of yourself all year long..
After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:
- Getting important screenings
- Getting vaccines for older adults
- Keeping your heart healthy
- Preventing type 2 diabetes
- Lowering your risk of falling
Your plan could also include:
- Getting active
- Eating healthy
- Quitting smoking
- Watching your weight
Content last updated February 9, 2023
Reviewer Information
This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services
Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group
November 2022
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The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit .
Eligibility
Medicare Part B covers the Annual Wellness Visit if:
- You have had Part B for over 12 months
- And, you have not received an AWV in the past 12 months
Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit.
Covered services
During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:
- Check your height, weight, blood pressure, and other routine measurements
- This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
- This includes screening for hearing impairments and your risk of falling.
- Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
- Learn about your medical and family history
- Medications include prescription medications, as well as vitamins and supplements you may take
- Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
- Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
- Screen for depression
- Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after your first visit may be different. At subsequent AWVs, your doctor should:
- Check your weight and blood pressure
- Update the health risk assessment you completed
- Update your medical and family history
- Update your list of current medical providers and suppliers
- Update your written screening schedule
- Screen for cognitive issues
- Provide health advice and referrals to health education and/or preventive counseling services
If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider . This means you pay nothing (no deductible or coinsurance ). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your AWV, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
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FinanceBuzz
Don’t Miss These 13 Totally Free Things You Get With Medicare
Posted: April 28, 2024 | Last updated: April 28, 2024
Medicare is the government program that helps pay your bills during retirement. But it also offers a slew of free services that come as a pleasant surprise to many.
Here are 13 freebies included with Original Medicare plans that can help you keep more cash in your pocket and eliminate some money stress .
Note that these perks may not apply to those who have Medicare Advantage coverage.
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A preventative welcome visit
Within 12 months of signing up for Medicare, reach out to your doctor to schedule a preliminary “welcome to Medicare” visit.
Unlike an annual checkup, your welcome visit is a one-time appointment where you and your primary care provider go over your medical history in depth.
The appointment includes a few basic screenings, such as a vision test. Your doctor will also create a preventative care plan, which lays out which screenings and vaccines you should get as you enter your golden years.
Although you will not pay a deductible for this visit, you might be responsible for a coinsurance. In addition, your deductible might apply if the doctor performs some types of additional tests.
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Yearly wellness visits
While Medicare doesn’t cover annual checkups (often called physicals), it does cover an annual wellness visit. During the appointment, you’ll complete a risk assessment that lays out conditions you could develop based on your lifestyle, family history, and other factors.
Your doctor will use the results of the assessment to update the care plan created during your one-time welcome visit. Note that you can’t schedule a free annual wellness visit within the first 12 months of signing up for Medicare Part B.
Seasonal vaccines
Medicare Part B covers a variety of seasonal vaccines that those age 65 and older should receive annually, including a yearly flu shot and COVID-19 booster.
Taking advantage of these free vaccines can be helpful for seniors, who are at a greater risk of experiencing complications, hospitalizations, and death related to some illnesses.
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Other recommended vaccines
Medicare Part D recently expanded to fully cover the cost of vaccines for adults that the Advisory Committee on Immunization Practices (ACIP) recommends. Vaccines for shingles, tetanus-diphtheria-whooping cough, and more are included.
Patients who have Medicare Part D and were charged an administration fee when receiving necessary vaccines this year can file a claim to get reimbursed.
Opioid use disorder treatment
Medicare covers recovery treatments for opioid use disorder without requiring you to pay a copay if you receive your through an opioid treatment program (OTP) enrolled in Medicare.
Your treatment plan might include medication, therapy, overdose training, ongoing assessments, and drug tests. However, note that your Medicare Part B deductible does apply to any medications or other supplies you receive as part of your treatment plan.
Yearly screenings for depression
Medicare Part B recipients can get a free depression screening at their primary care provider’s office once a year.
During a depression screening, you might be asked questions about changes in your sleeping habits, energy levels, and eating habits, plus questions about any feelings of hopelessness or guilt.
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Yearly mammograms for women over 40
If you have Medicare and are a woman over age 40, you should be eligible for a free annual mammogram.
Medicare fully covers a basic yearly screening. Additional mammograms that are deemed medically necessary might also be covered, but you are likely to pay some of the cost.
Yearly prostate cancer screenings for men over 50
If you’re a man with Medicare Part B, you’ll qualify for yearly prostate-specific antigen (PSA) lab screenings and a digital rectal exam starting the day after your 50th birthday,
Colonoscopy screenings every 2 or 10 years
If you are at high risk for colon cancer, Medicare will cover the full cost of a basic screening colonoscopy once every two years.
Medicare will cover the screening in full for those not at high risk once every 10 years. Medicare also covers one colonoscopy four years after a flexible sigmoidoscopy.
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Twice-yearly diabetes screenings
If your primary care provider thinks you could develop diabetes and recommends you for screening, Medicare will cover the cost of up to two blood glucose lab tests per year.
You’re also eligible for up to two free screenings if you’re older than 65, overweight, and have either a personal or family history of diabetes (including gestational diabetes).
Medicare Diabetes Prevention Program (MDPP)
If you don’t have diabetes or end-stage renal disease, do have a BMI over a certain limit (usually either 23 or 25), and haven’t yet gone through a Medicare Diabetes Prevention Program, Medicare will typically cover the full costs of a year-long preventative course.
The free program spans 12 months and has two distinct phases. First, you’ll attend six months of weekly group meetings, where you’ll learn strategies for lowering your risk of developing type 2 diabetes.
Second, you’ll qualify for monthly check-ins over the next six months to help you meet health goals and maintain healthy habits.
Screenings for alcohol misuse
Every year, Medicare recipients qualify for a free alcohol misuse screening at their primary care provider’s office.
If your primary care physician flags you for potentially misusing alcohol — which is different from receiving a concrete alcohol dependency diagnosis — you could qualify for up to four short counseling sessions per year to discuss a path forward.
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Up to 8 smoking-cessation counseling sessions
If you want to stop smoking or using tobacco and your doctor recommends that you try to quit, Medicare will cover the full cost for as many as eight smoking-cessation counseling visits over the course of 12 months.
Bottom line
Dealing with new health insurance in retirement requires a bit of a learning curve. But once you’ve figured out how Medicare works, you can start taking advantage of the many free services the program provides to stretch your Social Security income .
Call your primary care provider’s office as soon as you’ve signed up for Medicare and schedule your one-time welcome visit to start taking advantage of these free services.
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How to avoid Medicare annual wellness visit denials
If you’re seeing a high number of denials for Medicare annual wellness visits (AWVs), you’re not alone. Identifying whether to code for an Initial Preventive Physical Exam (IPPE, or the “Welcome to Medicare” visit), an initial Medicare AWV, or a subsequent Medicare AWV can be tricky.
Common reasons for denial include the folllowing:
1. Billing a G0438 (initial Medicare AWV) or G0439 (subsequent Medicare AWV) when the patient has been enrolled in Medicare Part B for 12 months or less. This situation instead calls for billing G0402 (IPPE).
2. Billing for a Medicare AWV when the patient only has Medicare Part A . They must have Part B coverage as well.
3. Using the wrong primary diagnosis code. If the primary diagnosis code is problem-oriented (e.g., diabetes or hypertension), Medicare will most likely deny a claim for an AWV, because AWVs are “well visits.” Instead, list a well code (e.g., Z00.0X, “encounter for general adult exam”) as the primary diagnosis.
The IPPE also has a slightly different set of required components (e.g., advance care planning and visual acuity screening with documentation of results in the note) than the two types of AWVs (e.g., instrumental activity of daily living and assessment of cognitive function).
Here are some frequently asked questions to help you further navigate the world of AWV billing, as well as a side-by-side comparison of the three types of Medicare wellness visits.
Q - What is the difference between a Medicare AWV and a preventive visit?
A - Medicare AWVs consist of three specific visit types statutorily covered by Medicare with no co-pay or deductible. They are the IPPE (the “Welcome to Medicare” visit, G0402), the initial AWV (G0438), and the subsequent AWV (G0439). These visits do not require a comprehensive physical exam. Preventive visits (9938X and 9939X) are covered by commercial/managed care and Medicaid plans and require a comprehensive physical exam. They are also include no co-pay or deductible.
Q - Can a Medicare patient receive a preventive visit?
A - Yes, but traditional Medicare does not cover these visits (9938X and 9939X are statutorily prohibited), so patients with that coverage will have to pay 100% out-of-pocket. However, some Medicare Advantage plans cover both Medicare AWVs (G codes) and non-Medicare (commercial) preventive visits (9938X and 9939X). Medicare Advantage patients would need to check their plan benefits to find out if they have coverage for both.
Q - Is the IPPE the same as the initial AWV?
A - No, the IPPE is the Initial Preventive Physical Examination, also known as the "Welcome to Medicare" visit (G0402), while the initial AWV (G0438) is the patient’s first Medicare AWV following the IPPE. These are two different types of visits, and billing a G0438 when the patient was actually only eligible for a G0402 is a common cause of denials.
Q - What diagnosis code should I use to bill a Medicare wellness exam?
A - Use the Z00 family of codes.
Q - Do Medicare wellness visits need to be performed 365 days apart?
A - No. A Medicare wellness visit may be performed in the same calendar month (but different year) as the previous Medicare wellness visit. For example, if a patient had a Medicare AWV on June 30, 2020, then that patient is eligible again on June 1, 2021. If a patient had a Medicare AWV on June 1, 2020, then that patient is also eligible again on June 1, 2021. But if you bill a Medicare AWV for either patient on May 31, 2021, it will be denied, because it is in a different calendar month and too soon.
Q - Can I bill for a Medicare AWV and a commercial insurance preventive visit for the same patient in the same year?
A - Yes, you can do this if the patient has both as part of their covered benefits. Some patients have a commercial payer as their primary insurance and Medicare as their secondary.
Q - Can I perform Medicare wellness visits in skilled nursing facilities or as home visits?
A - Yes. Just make sure the place of service (POS) on the claim corresponds to the correct location.
Q - Can I perform a pap smear or pelvic exam during a Medicare AWV?
A - Yes, and they are both separately billable. Use code Q0091 for the screening pap smear in a Medicare patient. The pelvic exam must be combined with a breast exam and then billed together using G0101. Specific documentation components are required for the G0101.
Q - If a patient has a managed Medicare plan (non-traditional Medicare), can I still bill a G code (G0402, G0438, or G0439) for a wellness visit?
A - Yes. Traditional Medicare and all managed Medicare plans will accept the G codes for AWVs.
Q - Can I bill a routine office visit with a Medicare AWV?
A - When appropriate, a routine office visit (9920X and 9921X) may be billed with a Medicare AWV. Modifier -25 should be appended to the evaluation and management (E/M) code. Cost sharing will apply to the E/M service, though, just as it would without the Medicare AWV. Make sure patients are aware of this, as some may expect that all services provided on the same day as the Medicare AWV are covered at 100%.
Which type of Medicare AWV is this?
— Vinita Magoon, DO, JD, MBA, MPH, CMQ, Baylor Scott & White Health, Temple, Texas
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IMAGES
VIDEO
COMMENTS
Learn what this preventive visit includes, how much you pay, and what to bring to your appointment. Find out how to schedule your visit and get a written plan of preventive services you need.
Learn the seven elements of the initial preventive physical exam for Medicare beneficiaries, including how to bill for it and what to do if you identify modifiable risk factors for depression or fall risk. The article provides tips and strategies for a well-planned routine that covers the required elements in a short time.
A 'Welcome to Medicare' physical is a preventive health checkup for new enrollees in Medicare Part B. It includes blood pressure, heart rate, height, weight, BMI, vision and mental health assessment. It also offers healthcare information and preventive care recommendations. Medicare covers the cost of this visit but not the tests or treatments.
Learn how to get one free Welcome to Medicare checkup in the first 12 months of Part B enrollment. Find out what your doctor will do, what to bring and what to ask during this visit.
Annual Wellness Visit (AWV) Visit to develop or update a personalized prevention plan and perform a health risk assessment. Covered once every 12 months. Patients pay nothing (if provider accepts assignment) Routine Physical Exam. Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.
A one-time appointment to promote general health and prevent diseases when you are new to Medicare. Eligible for 100% coverage by Original Medicare and no deductibles, copayments, or coinsurance by Medicare Advantage Plans. Includes checkups, education, counseling, and referrals related to your risk factors and health needs.
Learn what the Welcome to Medicare visit is, who is eligible, what services are covered, and how to prepare for this exam. Find out how to access preventive care and other health screenings upon enrolling in Medicare.
The "Welcome to Medicare" visit is a one-time-only preventative health care visit covered by Medicare Part B. It is not the same as a routine physical exam or annual Medicare Wellness visit. The Welcome to Medicare visit is an introduction to Medicare and focuses on disease prevention and detection to help beneficiaries live a healthier life.
Original Medicare Part B covers all the costs of one "Welcome to Medicare" preventive visit during the first 12 months you have Part B. This visit with a Medicare-approved doctor sets the baseline for your treatment moving forward. You forfeit your opportunity for a "Welcome to Medicare" visit after 12 months on Part B, but you will then be eligible for a similar annual wellness visit ...
A Welcome to Medicare visit is a free preventive checkup for new-to-Medicare members. Learn what it includes, when to schedule it, what to bring and how it differs from an Annual Wellness Visit.
The "Welcome to Medicare" physical exam is a one-time, preventive physical exam Medicare covers within the first 12 months that you have Medicare Part B. The visit will include a thorough review of your health, along with education and counseling about the preventive services you need, like certain screenings, shots, and referrals for other care.
a Welcome to Medicare Visit or an Annual Wellness Visit, you can schedule a problem-oriented visit or "sick visit" with your doctor. The fees for the exam and related medical tests will be submitted to Medicare and applied to your deductible and copay. Frequently-Asked Questions, continued.
The Initial Preventive Physical Examination (IPPE) is also known as the "Welcome to Medicare Preventive Visit.". The IPPE is a preventive visit offered to newly-enrolled Medicare beneficiaries ...
With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment. If you get any tests or services that aren't included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.
Medicare Part B covers the Annual Wellness Visit if: You have had Part B for over 12 months; And, you have not received an AWV in the past 12 months; Additionally, you cannot receive your AWV within the same year as your Welcome to Medicare preventive visit. Covered services. During your first Annual Wellness Visit, your PCP will develop your ...
Within 12 months of signing up for Medicare, reach out to your doctor to schedule a preliminary "welcome to Medicare" visit. Unlike an annual checkup, your welcome visit is a one-time ...
2. Billing for a Medicare AWV when the patient only has Medicare Part A. They must have Part B coverage as well. 3. Using the wrong primary diagnosis code. If the primary diagnosis code is problem ...
Get reminders about open enrollment, ways to save costs, and more. The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.
How Medicare works. Medicare is a fee-for-service plan that's managed by the federal government. It covers 80% of Medicare-approved services, and the beneficiary, or person who has Medicare, is responsible for the remaining 20%. You can discover which services are approved and what amount is approved for that service on the Medicare website.
Advance care planning is a billable, face-to-face service between a physician (or nurse practitioner, physician assistant, or clinical nurse specialist) and a patient and/or surrogate (e.g., health care agent, designated decisionmaker, family member, or caregiver) to discuss and make known the patient's health care wishes in case the patient becomes unable to make health care decisions for ...
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