welcome to medicare visit template

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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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The Welcome to Medicare preventive visit is a one-time appointment you can choose to receive when you are new to Medicare. The aim of the visit is to promote general health and help prevent diseases.

Eligibility

Medicare Part B covers your one-time Welcome to Medicare preventive visit. Note that you must receive this visit within the first 12 months of your Part B enrollment .

Covered services

During the course of your Welcome to Medicare preventive visit, your provider should:

Check your height, weight, blood pressure, body mass index (BMI), and vision
Review your medical and social history
Review your potential for depression and other mental health conditions
Review your ability to function safely in the home and community
Provide you with education, counseling, and referrals related to your risk factors and other health needs
Give you a checklist and/or written plan with information about other preventive services you may need

The Welcome to Medicare preventive visit is not a head-to-toe physical. This visit is also separate from the Annual Wellness Visit (AWV) , which you can choose to receive once each year.

Original Medicare covers the Welcome to Medicare preventive 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 this visit 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 preventive visit, 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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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.

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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.

Ready for a new Medicare Advantage plan?

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.

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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.

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“Welcome to Medicare” preventive visit TRUSTED & VERIFIED medicare.gov . medicare.gov.

Yearly “Wellness” visits . medicare.gov.

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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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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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use .

Yearly "Wellness" visits

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 your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment .

The Part B deductible doesn’t apply.

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

Routine measurements (like height, weight, and blood pressure).
A review of your medical and family history.
A review of your current prescriptions.
Personalized health advice.
Advance care planning .

Your doctor or other health care provider will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or other health care provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

If you have a current prescription for opioids, your doctor or other health care provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your doctor or other health care provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use , and refer you for treatment, if needed.

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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.
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