Age and wellness visits | Eligibility for Welcome to Medicare

Question:

Does the patient need to be 65 years old in order to bill the Welcome to Medicare Visit?

Answer:

This is almost a trick question. 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. The patient is eligible for the Welcome to Medicare visit during the first year after enrolling in Medicare. Since most patients enroll at age 65, those patients are indeed eligible from age 65 to 66.

But, 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. And, other patients for whom Medicare is a Secondary Payer, because they continue to work.

Medicare’s “Medicare Wellness Visits” resource says this about the IPPE, or “Welcome to Medicare” visit,

• Medicare pays for one patient IPPE per lifetime not later than the first 12 months after the patient’s Medicare Part B benefits eligibility date.
• Medicare pays the IPPE costs if the provider accepts assignment.
• The eligibility for the service is based on the patient’s enrollment in Medicare, not age.

This is what is says about eligibility for Annual Wellness Visit services: “Medicare covers an AWV that delivers Personalized Prevention Plan Services (PPPS) for patients who:

• Are no longer within 12 months after the patient’s Medicare Part B benefits eligibility date
• Did not get an IPPE or AWV within the past 12 months”

Citations:

Medicare Wellness Visits MLN resource

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html

Additional resources:

• Wellness visits
• Medicare Rules

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