Seven components of IPPE – Initial Preventive Physical Examination

The IPPE is a preventive Evaluation and Management (E/M) service that includes seven components. These seven components enable the Medicare provider to identify risk factors that may be associated with various diseases and to detect diseases early when outcomes are best. The provider is then able to educate and counsel the beneficiary about the identified risk factors and possible lifestyle changes that could have a positive impact on the beneficiary’s health. The IPPE includes all of the following services furnished to a beneficiary by a physician or other qualified non-physician practitioner:

Component 1 – Review of the beneficiary’s medical and social history with attention to modifiable risk factors for disease detection

Medical history includes, at a minimum, past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments; current medications and supplements, including calcium and vitamins; and family history, including a review of medical events in the beneficiary’s family, including diseases that may be hereditary or place the individual at risk.

Social history includes, at a minimum, history of alcohol, tobacco, and illicit drug use, diet, and physical activities.

Component 2 – Review of the beneficiary’s potential risk factors for depression and other mood disorders

This includes current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression. The physician or other qualified non-physician practitioner may select from various available standardized screening tests that are designed for this purpose and recognized by national
professional medical organizations.

Component 3 – Review of the beneficiary’s functional ability and level of safety

This is based on the use of appropriate screening questions or methods. The physician or other qualified non-physician practitioner may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations. This review must include, at a minimum, the following areas:

Hearing impairment,
Activities of daily living,
Falls risk, and
Home safety.

Component 4 – An examination

This examination includes measurement of the beneficiary’s height, weight, and blood pressure; measurement of body mass index; a visual acuity screen; and other factors as deemed appropriate by the physician or qualified non-physician practitioner, based on the beneficiary’s medical and social history and current clinical standards.

Component 5 – End-of-life planning

The IPPE includes end-of-life planning as a required service, upon the beneficiary’s consent. End-of-life planning is verbal or written information provided to the beneficiary regarding:

The beneficiary’s ability to prepare an advance directive in the case that an injury or illness causes the beneficiary to be unable to make health care decisions, and Whether or not the physician is willing to follow the beneficiary’s wishes as expressed in the advance directive.

Component 6 – Education, counseling, and referral based on the previous five components

Education, counseling, and referral, as determined appropriate by the physician or qualified non-physician practitioner, based on the results of the review and evaluation services described in the previous five components. Examples include the following:

Counseling on diet if the beneficiary is overweight,
Education on prevention of chronic diseases, and
Referral for smoking and tobacco-use cessation counseling.

Component 7 – Education, counseling, and referral for other preventive services

Education, counseling, and referral, including a brief written plan, such as a checklist, provided to the individual for obtaining a screening electrocardiogram (EKG), if appropriate, and the appropriate screenings and other preventive services that are covered as separate Medicare Part B benefits, as listed below:

Bone mass measurements;
Cardiovascular screening blood tests;
Colorectal cancer screening tests;
Diabetes screening tests;
Diabetes outpatient self-management training services;
Medical nutrition therapy for individuals with diabetes or renal disease;
Pneumococcal, influenza, and hepatitis B vaccines and their administration;
Prostate cancer screening tests;
Screening for glaucoma;
Screening for Human Immunodeficiency Virus (HIV) for high risk individuals;
Screening mammography;
Screening Pap test and screening pelvic examinations;
Smoking and tobacco-use cessation counseling for asymptomatic individuals; and
Ultrasound screening for abdominal aortic aneurysms.

Please note:

1. The IPPE is a unique benefit available only for beneficiaries new to the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part B coverage.

2. This exam is a preventive visit and not a “routine physical checkup” that some seniors may receive every year or two from their physician or other qualified non-physician practitioner. Medicare Part B does not provide coverage for routine physical exams.

3. The IPPE does not include any clinical laboratory tests. The physician, qualified non-physician practitioner, or hospital may also provide and bill separately for the screening and other preventive services that are currently covered and paid for by Medicare Part B.

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