Wiki 99387 & 99397

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99387 & 99397

According to MLN Matters MM7079, you should report G0438 & G0439 or annual checkups.
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I have providers who see medicare patients for there annual check ups and they are using CPT codes 99387 or 99397 and medicare is not paying for the services. Should we be using the HCPCS codes G0438 & G0439?

Thanks
Lisa
 

airart

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Medicare Wellness

Yes, That is correct. Here is the MLN Matters for you to read that explains in detail when to use each one.

MLN Matters® Number: MM7079
Related Change Request (CR) #: 7079
Related CR Release Date: February 15, 2011
Effective Date: January 1, 2011
Related CR Transmittal #: R138BP and R2159CP
Implementation Date: April 4, 2011

Annual Wellness Visit (AWV), Including Personalized Prevention Plan
Services (PPPS)

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm7079.pdf
 
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I disagree, Ami. The initial AWV G0438 and subsequent G0439 do not include a physical exam. The preventive medicine codes 9938X-9939X which include exams should be billed with GY modifier so secondary insurance will pick up, otherwise the patient is responsible for these services.
 

bonn715

Contributor
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the GY is not necessary since physicals are a statutory exclusion for medicare (no ABN needed either), they will deny as not covered regardless and if secondary has benefits for it they will pay it. If you have a GY modifier on it often Replacement plans or the secondary commercial payors will deny due to the GY modifier being on the charge.
there is a big difference between the physical exam and the Wellness Visit though, so the documentation has to support what was done. It will also be denied if you use the wrong code for the Wellness Visit, so the first year they are eligible for Part B is for the Initial Preventative Exam, since they didnt have that until a few years ago they may or may not have had an IPPE but it doesnt matter as far as billing the initial Wellness Visit, and the subsequent Wellness Visits

good luck to you
 
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