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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 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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Last revised December 16, 2020 - Betsy Nicoletti
Tags: Medicare, Medicare rules, preventive medicine services, primary care, Wellness Visits

Looking for training on the new E/M Guidelines for 2021?

"Documentation Essentials for Codes 99202-99215 in 2021" is now available!

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

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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