Oops! MAC Denies Annual Wellness Visit Claims
At least one Medicare administrative contractor (MAC) has reportedly denied annual wellness visit (AWV) claims in error. The Patient Protection and Affordable Care Act of 2010 (PPACA) provides for the implementation of Medicare AWVs. Full Medicare Part B coverage and payment of the AWV went into effect Jan. 1.
The Centers for Medicare & Medicaid Services (CMS) instructs providers to report the initial AWV with HCPCS Level II code G0438 Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit and all subsequent AWVs with G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit.
Medicare providers also must report a diagnostic code on the claim. Although there are no specific ICD-9-CM diagnosis codes required for the AWV, there are certain diagnosis codes providers shouldn’t report—as some providers discovered the hard way.
Cahaba GBA erroneously denied claims for G0438/G0439 when billed with a routine service diagnosis code due to an auto-deny edit. Medicare does not typically pay for routine services. The Part B MAC for jurisdiction 10 (Alabama, Georgia, and Tennessee) says mass adjustments were initiated Jan. 31; no provider action is required. Providers should contact their local contractors for proper coding guidance.
Cahaba GBA also reported, Jan. 14, that the deductible for certain HCPCS Level II preventive/screening codes were applied in error. Certain preventive/screening services are no longer subject to a deductible, effective Jan. 1, implemented by CMS in accordance to the PPACA. Cahaba GBA is correcting their internal files and automatically adjusting claims.