Which provider can perform IPPE And AWV - Eligibility guide

B. Who May Perform an IPPE or AWV

The contractor pays the appropriate physician fee schedule amount based on the rendering National Provider Identification (NPI) number.

The IPPE may be performed by:

• a doctor of medicine or osteopathy as defined in Section 1861(r) (1) of the Social Security Act, or

• a qualified nonphysician practitioner (nurse practitioner, physician assistant or clinical nurse specialist).

The AWV may be performed by a health professional, which is defined as:

• a doctor of medicine or osteopathy as defined in Section 1861(r)(1) of the Social Security Act,a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5) of the Social Security Act), or

• a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals,
working under the direct supervision of a physician (doctor of medicine or osteopathy).


C. Eligibility

1. IPPE

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 Part B coverage period.


2. AWV

Medicare pays for an AWV for a beneficiary who is no longer within 12 months after the effective date of his/her first Medicare Part B coverage period, and who has not received either an IPPE or an AWV providing PPPS within the past 12 months. Medicare pays for only one first AWV (HCPCS G0438), per beneficiary per lifetime. All subsequent AWVs must be billed using HCPCS G0439.