What is involved in a Welcome to Medicare visit for a new Medicare beneficiary, typically an individual 65 years or older or with certain disabilities?

Welcome to Medicare Visit Components

The Welcome to Medicare visit is a one-time preventive visit available within the first 12 months of Medicare Part B enrollment that includes a comprehensive health risk assessment, cognitive screening, depression screening, functional assessment, medication review, and personalized prevention planning. 1, 2, 3

Core Medical Assessment Components

The visit must include several mandatory elements to meet Medicare requirements:

• Medical and family history review to identify chronic conditions and cardiovascular risk factors including hypertension, dyslipidemia, diabetes, and autoimmune disorders 1, 2

• Comprehensive medication review of all prescription and over-the-counter medications, assessing medication-taking behavior, potential rationing, intolerances, side effects, and high-risk medications per Beers Criteria 1, 2

• Physical measurements including height, weight, BMI calculation, and blood pressure determination 2

• Immunization status verification to ensure compliance with age-appropriate vaccination schedules 1, 3

Cognitive and Mental Health Screening

Cognitive assessment is a critical component that should use the Mini-Cog as the primary screening tool, which takes only 2-4 minutes to administer and has 76% sensitivity and 89% specificity for detecting cognitive impairment. 1

• If the Mini-Cog is positive, perform a comprehensive cognitive evaluation including functional status assessment, neuropsychiatric symptom evaluation, and laboratory testing to rule out reversible causes 1

• Depression screening using validated tools such as the Patient Health Questionnaire-2 (PHQ-2) or Patient Health Questionnaire-9 (PHQ-9) is mandatory 2, 3

• Screen for anxiety and substance use, including tobacco and alcohol 1, 3

Functional and Geriatric Assessment

• Evaluate gait, balance, and mobility impairments as part of falls and mobility assessment 1

• Functional assessment to evaluate activities of daily living and mobility, particularly important for patients 65 years and older 2

Social Determinants of Health

A comprehensive social assessment must evaluate food security, housing stability, transportation access, financial security, and community safety. 1, 2, 3

Preventive Screening and Risk Factor Assessment

• Screen for chronic disease risk factors including hypertension, dyslipidemia, and diabetes 3

• Lipid profile including total, LDL, and HDL cholesterol and triglycerides if not done within the past year 2

• Diabetes screening with A1C testing if not available within the past 3 months 2

• For women: cervical cancer screening with Pap smear, clinical breast examination, mammography screening, and bone health assessment 2

Personalized Prevention Planning

Create a written personalized prevention plan based on identified risk factors and health needs, including referrals to health education and prevention counseling services. 2, 3

• Advance care planning discussions including identifying surrogate decision makers 2

• Ensure guideline-directed preventive therapy is in place for patients with established cardiovascular disease 1, 3

Critical Pitfalls to Avoid

Never substitute a brief physical examination for the comprehensive preventive services required—Medicare covers and expects full preventive services including cognitive assessment, functional screening, and advance care planning. 1, 3

• Do not neglect cognitive screening, as routine screening can increase detection rates two to threefold 1

• Mental health and substance abuse screening are critical components directly impacting morbidity and mortality and must not be omitted 3

• Address health disparities proactively, as Black and Hispanic populations are less likely to receive these visits and are diagnosed with cognitive impairment at later stages 1

Billing Considerations

Use Medicare-specific G-code G0402 for the Welcome to Medicare visit, which is distinct from G0438 (initial Annual Wellness Visit) and G0439 (subsequent Annual Wellness Visits). 1, 4

The visit must be performed within the first 12 months of Medicare Part B enrollment and can only be billed once per beneficiary 4, 5. Despite the Affordable Care Act waiving coinsurance in 2011, utilization rates remain suboptimal at approximately 12% as of 2016, representing a significant missed opportunity for preventive care 5.