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
Traditional Medicare does not pay for routine services reported with codes 99381—99397.
Preventive Codes Medicare Covers
- 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 | 2020 wRVU |
National non-facility payment | National facility payment |
| G0101 |
Cervical or vaginal cancer screenings; pelvic and clinical breast exam |
0.45 | $40.78 | $29.23 |
| Q0091 |
Screening pap smear, obtaining preparing and conveyance of cervical or vaginal smear to laboratory |
0.37 | $43.67 | $19.49 |
| G0402 |
Welcome to Medicare Visit |
2.43 | $168.54 | $129.20 |
| G0438 |
Initial Annual Wellness Visit |
2.43 | $172.87 | $172.87 |
| G0439 |
Subsequent Annual Wellness Visit |
1.50 | $117.29 | $117.29 |
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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