Annual Wellness Visit (AWV)a  
Human Immunodeficiency Virus (HIV) Screening
Bone Mass Measurements
Medical Nutrition Therapy (MNT)
Cardiovascular Screening Blood Tests   
Prostate Cancer Screening
Colorectal Cancer Screening
Seasonal Influenza, Pneumococcal, and Hepatitis B Vaccinations andtheir Administration
Counseling to Prevent Tobacco Useb                
Screening Mammography
Diabetes Screening Tests                                
Screening Pap Tests and Pelvic Examination
Diabetes Self-Management Training (DSMT)
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)c
Glaucoma Screening

Medicare Preventive Service

Components of the IPPE

1. Review of beneficiary’s medical and social history
At a minimum, obtain the following:
     Past medical/surgical history (experiences with illnesses, hospital stays, operations, allergies, injuries, and treatments);
     Current medications and supplements (including calcium and vitamins);
     Family history (review of medical events in the family, including diseases that may be hereditary or place the beneficiary at risk);
     History of alcohol, tobacco, and illicit drug use;
     Diet; and
     Physical activities.
2. Review of beneficiary’s potential risk factors for depression and other mood disorders
Use any appropriate screening instrument for persons without a current diagnosis of depression recognized by national professional medical organizations to obtain current or past experiences with depression or other mood disorders.
3. Review of beneficiary’s functional ability and level
of safety
Use any appropriate screening questions or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the following areas:
Hearing impairment;
Activities of daily living;
Falls risk; and
Home safety.
4. An examination
Obtain the following:
Height, weight, and blood pressure;
Visual acuity screen;
Measurement of body mass index; and
Other factors deemed appropriate based on the beneficiary’s medical and social history and current clinical standards.
5. End-of-life planning
End-of-life planning is 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.
6. Education, counseling, and referral based on the previous five components
Based on the results of the review and evaluation services provided in the previous five components, provide education, counseling, and referral as appropriate.
7. Education, counseling, and referral for other
preventive services
Complete a brief written plan, such as a checklist, to be given to the beneficiary for obtaining a screening electrocardiogram (EKG), as appropriate, and the appropriate screenings and other preventive services that are covered as separate Medicare Part B benefits. (See below for a list of Medicare-covered
preventive services.)