evmundy
Guest
does medicare pay for a digital prostate exam during the AWV? getting mixed info
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Wiki g0102
- Thread starter evmundy
- Start date
thomas7331
Guest
G0102 is covered by Medicare once per year for male patients over 50 years old. The AWV does not have any exam components, so there is no overlap between these and there are no CCI edits between the two codes, so no modifiers should be necessary.
OpenClaims
Guest
Here is a link to specifics regarding Medicare and G0102/03/01. As Thomas mentioned, it is covered for males over 50 annually.
Mcare says G0102 is bundled with the separate E/M. If you are billing the AWV, prostate exam, and separate E/M visit, the prostate exam is included in the E/M. If you are billing the AWV and prostate exam only, both should be paid. I have had both paid on the same date when billed as G0438/G0439 and G0102 only. If bundled, you cannot bill the patient, due to inclusivity.
thelms
New
Medicare revised ncci guide chapter 12 for supplemental services state "
3. HCPCS code G0102 (Prostate cancer screening; digital rectal examination) is not
separately payable with an E&M code (e.g., CPT/HCPCS codes 99202-99499, G0463, G0466-
G0470, G0438, G0439)." Does that mean is billable separately with welcome to medicare G0402?
3. HCPCS code G0102 (Prostate cancer screening; digital rectal examination) is not
separately payable with an E&M code (e.g., CPT/HCPCS codes 99202-99499, G0463, G0466-
G0470, G0438, G0439)." Does that mean is billable separately with welcome to medicare G0402?