Question:
Does the patient need to be 65 years old in order to bill the Welcome to Medicare Visit?
Answer:
No, there is no age restriction for billing Medicare for the Welcome to Medicare visit, the initial annual wellness visit or the subsequent annual wellness visit.
Although we think of people being eligible for Medicare at age 65, there are many individuals who are eligible for Medicare at a younger age, because they have qualified for Social Security Disability Insurance (SSDI). A patient is eligible for Medicare after 24 months on SSDI.
Medicare’s “The ABCs of the Initial Preventive Physical Examination (IPPE)” also known as the Welcome to Medicare visit says this,
“Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary’s first Medicare Part B coverage period.”
The eligibility for the service is based on the patient’s enrollment in Medicare, not age.
And their publication “The ABCs of the Annual Wellness Visit” gives this as the eligibility for those services: “Medicare covers an Annual Wellness Visit (AWV) providing Personalized Prevention Plan Services (PPPS) for beneficiaries who:
- Are no longer within 12 months after the effective date of their rst Medicare Part B coverage period
- Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months”
Citations:
ABC’s of IPPE
ABC’s of wellness
More resources on Wellness visits and Medicare Rules
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