Components of the Initial Preventive Physical Examination

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 othermood 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
Home safety

Component 4 -- A physical examination
This examination includes measurement of the beneficiary’s height, weight, and blood pressure; measurement of body mass index (required service effective January 1, 2009); 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

Effective for dates of service on or after January 1, 2009, 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
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 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 mammography
Screening Pap test and screening pelvic examinations
Ultrasound screening for abdominal aortic aneurysms

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