Initial Preventive Physical Examination and Annual Wellness Visit
Reimbursement and claims payment guidance for Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) services for Humana Medicare Advantage products and providers billing Humana.
No material clinical or coverage changes in this revision.
IPPE and AWV Coverage Rules
IPPE/AWV coverage criteria
Covered when the following coverage and frequency rules are met for Humana Medicare Advantage members:
ALL of the following
- IPPE (HCPCS G0402) reimbursed once per lifetime if provided within the first 12 months after the effective date of the member's first Medicare Part B coverage period.
- Initial AWV (HCPCS G0438) reimbursed once per lifetime beginning in the calendar year following the IPPE; reimbursement of the initial AWV is not dependent on reimbursement of an earlier IPPE.
- Subsequent AWV (HCPCS G0439) reimbursed once per calendar year beginning in the calendar year following an allowed charge for HCPCS G0438; reimbursement of a subsequent AWV is not dependent on reimbursement of an earlier AWV or IPPE.
- Humana limits reimbursement to only one of HCPCS codes G0402, G0438, or G0439 per calendar year.
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