Initial Preventive Physical Examination and Annual Wellness Visit
Humana Medicare Advantage reimbursement policy for one-time Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) services for Medicare Advantage members; intended for providers submitting claims to Humana.
No material clinical or coverage changes in this revision.
IPPE and AWV Reimbursement Criteria
IPPE and AWV reimbursement criteria
Reimbursement rules and limits for IPPE and AWV services under Humana Medicare Advantage plans.
ALL of the following
- IPPE (HCPCS G0402) reimbursed once per lifetime and only if provided within the first 12 months after 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 G0438 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 G0438; reimbursement of G0439 is not dependent on reimbursement of an earlier AWV or IPPE.
- Humana limits reimbursement to only one of the services G0402, G0438 or G0439 per calendar year.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.