HCPCS G0402: Initial Preventive Physical Exam (Welcome to Medicare)
HCPCS G0402 is the Initial Preventive Physical Examination (IPPE), the once-per-lifetime "Welcome to Medicare" visit available in the first 12 months of Part B enrollment. In 2026 Medicare pays about $174.69 non-facility (5.23 total RVUs times the $33.4009 conversion factor) and about $114.23 in a facility.
- Code type
- Initial Preventive Physical Exam (IPPE)
- 2026 non-facility
- $174.69 (5.23 RVUs)
- 2026 facility
- $114.23 (3.42 RVUs)
- Frequency
- Once per lifetime, first 12 months of Part B
What is HCPCS G0402 used for?
G0402 is the Initial Preventive Physical Examination (IPPE), better known as the "Welcome to Medicare" visit. It is a one-time preventive assessment, review of history, risk factors, functional ability, vital signs, vision, and a written screening schedule, offered to new beneficiaries in their first year of Part B. It is not a head-to-toe physical; it is a preventive and planning visit.
Eligibility is narrow: the beneficiary must be within the first 12 months of Part B enrollment, and the code is payable only once in a lifetime. Past that 12-month window the IPPE is no longer billable and the patient moves to the Annual Wellness Visit codes instead, so verifying the Part B effective date is the first step before you ever drop G0402.
How much does G0402 pay in 2026?
G0402 carries 5.23 non-facility RVUs and 3.42 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $174.69 non-facility and $114.23 in a facility. As a covered preventive service it generally waives the deductible and coinsurance when billed correctly, so the beneficiary usually owes nothing. When a distinct, medically necessary problem is handled at the same visit, a problem E/M (99202-99215) may be reported with modifier 25 alongside it. Model it on the Medicare fee calculator.
Eligibility and the Medicare wellness family
The three Medicare wellness codes are sequential, not interchangeable:
| Code | Visit | Frequency |
|---|---|---|
| G0402 | IPPE (Welcome to Medicare) | Once, first 12 months of Part B |
| G0438 | Initial Annual Wellness Visit | Once ever, after first 12 months |
| G0439 | Subsequent AWV | Every 12 months thereafter |
Because the IPPE, initial AWV, and subsequent AWV each have their own frequency rules, routing a patient to the wrong one is the main billing pitfall in this family.
Frequently asked questions
Only Medicare beneficiaries within the first 12 months of Part B enrollment, and only once per lifetime. If a patient is past their first 12 months, the IPPE is no longer billable; they move to the Annual Wellness Visit codes instead. Verify the Part B effective date before billing G0402.
The 2026 national non-facility allowed amount is about $174.69 (5.23 total RVUs times $33.4009) and about $114.23 in a facility. The IPPE is a covered preventive service, so it is generally not subject to the deductible or coinsurance when billed correctly.
Yes, when the patient has a separately identifiable problem addressed at the same encounter, a problem E/M (99202-99215) may be billed with modifier 25. The IPPE covers the preventive elements; the E/M covers the distinct problem work. Document both clearly so the modifier 25 holds up.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
Stop losing revenue to problems like this.
A free billing audit shows exactly where your practice is leaking money — no cost, no commitment.
