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March 25, 2023

Preventive Medicine Services – Medicare

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Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits.  More tips for preventive medicine and split visits can be found here.

Definition

Original Medicare does not pay for routine services reported with codes 99381—99397.

Medicare Wellness Visits

  • G0402   Welcome to Medicare Visit
  • G0403, G0404, G0405   EKG for Welcome to Medicare Visit
  • G0438   Initial Annual Wellness Visit
  • G0439   Subsequent Annual Wellness Visit
  • G0101   Cervical or vaginal cancer screening; pelvic and clinical breast exam
  • Q0091   Screening pap smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

 

Code Description
G0101 Cervical or vaginal cancer screenings; pelvic and clinical breast exam
Q0091 Screening pap smear, obtaining preparing and conveyance of cervical or vaginal smear to laboratory
G0402 Welcome to Medicare Visit
G0438 Initial Annual Wellness Visit
G0439 Subsequent Annual Wellness Visit

Medicare Rules for Billing and Coding Preventive Services

Medicare patients now believe they are eligible for an annual “exam.” Although neither the Welcome to Medicare Visit or the Annual Wellness Visit requires an exam, many patients will expect it as part of the service. You can do an exam at the wellness visit.

Two other covered services are the pelvic and breast exam and obtaining a screening pap smear. These are covered annually for high-risk patients, and every other year for low risk patients.

Clinicians may bill for a problem oriented E/M service on the same day as these covered Medicare services. If both are billed, CMS tells us not to select the level of service based on any components of the AWV.

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Last revised September 21, 2022 - Betsy Nicoletti
Tags: preventive services for medicare, primary care_preventive services

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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