Screening for Other Sexually Transmitted Illnesses (STI)

This article covers CPT® and diagnosis codes used for screening for other sexually transmitted illnesses. It includes descriptions and screening criteria. To tell whether or not you can collect a co-pay for the testing or not can be found on the U.S. Preventive Services Task Force (USPTF) website [1]. The Affordable Care Act mandated that […]

Billing for Pap Smear

Billing for pap smears in a physician practice can be confusing for clinicians and coders alike. Pap smears can be screening services or diagnostic services There is a HCPCS code for obtaining a screening pap smear, Q0091 Performing a pelvic exam is either part of a preventive medicine service or problem oriented visit A new […]

G0101 Pelvic and Breast Exam

Medicare developed two HCPCS codes for screening services for women, without definitive frequency time limits Both G0101 (screening breast and pelvic exam) and Q0091 (obtaining a screening pap smear) may be billed every two years for a low-risk patient and every year for high-risk patients These are not comprehensive preventive medicine services They may be […]

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. See also Q&A from the Preventive Medicine […]

Age and Wellness Visits | Eligibility for Welcome to Medicare

Who can perform the AWV Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always […]

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442

The  US Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse and behavioral interventions for individuals whose screening results are positive. Medicare pays for an annual screening for alcohol misuse for all Medicare beneficiaries using HCPCS code G0442. For those who screen positive, Medicare also pays for a brief face-to-face behavioral counseling session, HCPCS […]

Intensive Behavioral Counseling for Cardiovascular Disease, HCPCS Code G0446

Medicare pays a primary care physician or other primary care practitioner in a primary care setting to annually provide one face-to-face behavioral counseling session for cardiovascular disease. Although CMS has developed a HCPCS code specifically for this service, many primary care clinicians perform this service as part of an E/M service or a wellness visit. […]

Behavioral Counseling for Obesity, HCPCS Code G0447

G0447 face-to-face behavioral counseling for obesity, 15 minutes G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician […]

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