Differences Between AWV, IPPE and Routine Physical Exams for Medicare Beneficiaries

PUBLISHED: Oct 4, 2018
Relevant to: Ambulatory Care, Medical Office

The U.S. Centers for Medicare and Medicaid Services (CMS) has an educational tool for Medicare fee for service providers that describes the differences between the Initial Preventive Physical Examination (IPPE), the Annual Wellness Visit (AWV) and routine physical examinations.

According to the MLN educational tool for Medicare beneficiaries:

  • Initial Preventive Physical Examination (IPPE): This is a visit that consists of a review of medical and social health history, and preventive services education. It is covered only once, within 12 months of Part B enrollment. The patient pays nothing (if provider accepts assignment).
  • Annual Wellness Visit (AWV): This is a visit to develop or update a personalized prevention plan and perform a health risk assessment. This visit is covered once every 12 months. The patient pays nothing (if provider accepts assignment).
  • Routine Physical Examination: This exam is performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury. This visit is not covered by Medicare. The patient pays 100% out-of-pocket for this exam.

Follow the link below to access the MLN Educational Tool. Included with today’s notice is are example policies for the AWV and the IPPE.

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