What is the billing code for Welcome to Medicare?
- Copayment/coinsurance applies
- Deductible waived G0402 on or after 01/01/11:
- Copayment/coinsurance waived
- Deductible waived G0403, G0404, G0405:
- Copayment/coinsurance applies
- Deductible applies
What does the 'Welcome to Medicare visit' include?
- Past medical records including any x-ray and lab reports
- Immunization records
- A list of all prescription and over-the-counter medications you take regularly
- Your family medical history, especially information about hereditary conditions
- Any existing advance directives or other health decision-making documents
What is the “Welcome to Medicare” wellness visit?
In addition to collecting a medical history, it may also include a vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam. Clinical laboratory tests are notincluded in either the Welcome to Medicare Visitor Annual Wellness Visit.
What are the Medicare annual wellness visit codes?
- Are no longer within 12 months after the beneficiary’s eligibility date for Medicare Part B benefits
- Have not received an IPPE or AWV within the past 12 months
- Medicare pays for only one "first" AWV per beneficiary per lifetime and pays for one "subsequent" AWV per year thereafter
How do I bill a Welcome to Medicare visit?
Remember that during the first year a patient has enrolled with Medicare, he is eligible for the Welcome to Medicare visit or Initial Preventative Physical Exam (IPPE). This exam is billed using HCPCS code G0402.
Is CPT G0402 covered by Medicare?
No. Medicare waives both the coinsurance/copayment and the Medicare Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG/EKG) (HCPCS codes G0403, G0404, or G0405).
What is the ICD 10 code for Medicare Annual Wellness visit?
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.
When can you bill G0402?
Coding procedure code G0402: Initial Preventive Physical Examination; face-to-face visit, services limited to a new patient during the first 12 months of Medicare enrollment. The screening EKG/ ECG is billable with HCPCS code(s) G0403,G0404, or G0405, when it is a result of a referral from an IPPE.
Can you bill G0402 and 99497 together?
Note: Both the G0402 and 99497 are considered preventive in this coding scenario. A Medicare patient would be responsible for a copayment, co-insurance, and/or deductible for the 99497 service, unless it is performed on the same day as a wellness visit , (G0402, G0438 or G0439).
What is the difference between 99381 and 99391?
A member asked, “In the CPT manual it states that 99381 is an 'Initial' and 99391 is a 'Periodic' comprehensive preventive exam.
How do I code a Medicare wellness visit?
Code for the wellness visit. An initial annual wellness visit (G0438) can be provided 12 months after the patient first enrolled or 12 months after he or she received the IPPE. A subsequent annual wellness visit (G0439) can then be provided annually.
What is the difference between CPT code 99213 and 99214?
In a typical 99213 visit, you may not need to review or update the patient's PFSH at all, but a 99214 requires at least one of those areas be reviewed and documented.
What is included in initial Medicare wellness visit?
This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these: Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed. Height, weight, and blood pressure measurements.
Is G0402 a CPT code?
0 -Initial preventive physical exam. This examination (referred to as the IPPE or “Welcome to Medicare Exam”) covers specific services for new Medicare beneficiaries.
What is the difference between G0439 and 99397?
A full physical exam, 99397, is different than an Annual Wellness Visit, G0438/G0439, or “Welcome to Medicare Exam”, G0402. A full physical 99397 or 99387 is NOT covered by Medicare and patients are responsible for the cost and can be billed.