Preventive Medicine Services – Medicare

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.

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	2021 wRVU	Total National non-facility RVUs	Total National facility RVUs
G0101	Cervical or vaginal cancer screenings; pelvic and clinical breast exam	0.45	1.14	0.80
Q0091	Screening pap smear, obtaining preparing and conveyance of cervical or vaginal smear to laboratory	0.37	1.26	0.55
G0402	Welcome to Medicare Visit	2.60	4.86	3.89
G0438	Initial Annual Wellness Visit	2.60	4.85	NA
G0439	Subsequent Annual Wellness Visit	1.92	3.83	NA

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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