Wiki Billing with Humana Medicare

[AnnaLWill]

GYN Office in Kentucky. In the last few months, we have gotten denials back from Humana Medicare saying that pt’s policy allow only 1 preventive appt per year. Pts say they had seen their PCP for a checkup before seeing us. We think that their PCPs are using 99397 for their wellness visit and then Humana Medicare is denying when we bill 99397 w/ Z01.419 and Pts are getting billed for their annual GYN exam. One Humana Rep said we can try coding with G0101 & Q0091 but I had thought these could only be used straight Medicare (red, white, blue cards) Pts.
Is their any other codes we can use?

 

[csperoni]

Each carrier makes their own decision regarding coverage and coding for annual gyn/well woman exams. Some will cover every year with preventive 99384-99397. Some will follow Medicare guidelines and will only reimburse G0101/Q0091 (some every year, some every 2 years). If the carrier advised to use G0101 & Q0091, that is most likely their policy. I usually ask for the actual policy # or somewhere I can read it myself.