Initial Preventive Physical Examination (IPPE)

70.5 - Initial Preventive Physical Examination (IPPE) (Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25) RHCs billing under the AIR system Medicare provides for coverage for one IPPE for new beneficiaries only, subject to certain eligibility and other limitations. Payment for the professional services will be made under the RHC AIR. However, RHCs can receive a separate payment for an encounter in addition, to the payment for the IPPE when they are performed on the same day. When IPPE is provided in an RHC, the professional portion of the service is billed on TOBs 71X, respectively, and the appropriate site of service revenue code in the 052X revenue code series and must include HCPCS code G0402. Additional information on IPPE can be found in Chapter 18, section 80 of Pub. 100-04 of the Medicare Claims Processing Manual. EKGs The professional component is included in the RHC AIR or FQHC PPS and is not separately billable. The technical component of an EKG performed at an RHC/FQHC is billed to Medicare on professional claims (Form CMS-1500 or 837P) under the practitioner’s ID following instructions for submitting practitioner claims for independent/freestanding clinics. Practitioners at provider-based clinics bill the applicable TOB to the A/B MAC using the base provider’s ID. FQHCs billing under the PPS: IPPE is qualifying visit when billed under G0468, for additional information on the payment specific codes and qualifying visits, please refer to section 60.2 of this manual. Under the FQHC PPS, IPPE does not qualify for a separate payment when billed on the same day with another encounter/visit.