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Billing G0438/G0439 to commercial insuranc

L

LYurovich

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3
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Middletown, PA
We recently started billing for a new practice. They are billing G0438 and G0439 to non-Medicare aged patients that have commercial insurances. In most cases, the commercial insurances are paying. As far as I knew, this was a Medicare code and would only be reimbursed by Medicare & Medicare Advantage plans. Any information or insight would be appreciated. I did reach out to United HC on one of the claims and got a very vague response, so I'm still not convinced these are processing and paying correctly. Thanks in advance!
 
G0438 and G0439 are Medicare-specific codes for Annual Wellness Visits and can only be billed to Medicare patients. These codes are specifically designed for use under Medicare's AWV benefit. Commercial insurers may pay for these codes due to lack of automatic checks or claims processing errors. It's important to correct it moving forward because if the insurer notices the error later, they could recoup the funds or deny claims in the future.
 
We are seeing the same issue. Some commercial payers reimburse G-codes while others deny them as non-covered. If they aren't allowed, why do they appear on certain fee schedules? Should we be billing these for commercial plans or not?
 
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