Wiki G0439 and 99397

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wilccm

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Can these be billed together. The way I understand it; both of these codes are wellness codes and we should only bill 1.
 
one or the other

Correct you can only bill one or the other (medicare annual wellness or a preventative examination). However if documentation supports it you can split bill the visit with a 99212 or 99213 with a modifier 25 attached.

As long as if besides the Medicare Annual Wellness they were also treated for an additional/seperate problem during the visit that is thoroughly documented/supported.
 
I need help. Can these be billed together? as when to check g0439 or 99397. what is the difference? the way I understand it; both codes are welfare codes and we only have to invoice 1.
 
Yeny5863 said:
I need help. Can these be billed together? as when to check g0439 or 99397. what is the difference? the way I understand it; both codes are welfare codes and we only have to invoice 1.
Click to expand...

99397 - Annual full hands on Physician exam, age appropriate counseling etc
G0439 - AWV this is cognitive service, not hands on.


Medicare does not pay for 99397
What is included in G0439 is listed here

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm7079.pdf
 
Last edited:
Agreed. Medicare will pay for only ONE preventive exam but this needs to be done within the first year of Medicare enrollment...G0402. Once that time has passed, Medicare patients are no longer eligible for an annual preventive exam. This is when the Annual Wellness Visit comes into play...G0438 and G0439.
 
g0438 and 99397

Hello,
I have a provider that seen a patient and billed 99397 instead of Welcome to Medicare. Can the provider see the patient again within the year to do the Welcome to Medicare visit?
Tricia
 
Medicare will not accept 99397, since they created their own preventive visits in the shape and form of G0402 (IPPE - Welcome to Medicare), G0438 (Initial Annual Wellness Visit), and G0439 (Subsequent Annual Wellness Visit).
If the patient has a commercial insurance, then 99397 would probably work; but you will never get Medicare to pay your provider a penny for 99397.
 
AWV + Preventive + OV

I have a provider that insists they can bill AWV with a Preventive with an EST OV. We know the preventive won’t be paid. My question is what would justify this? They keep stating the exam they are performing is more in detail than one they would do for an OV and the OV is justified by problems they encounter during the Preventive. I can’t find anything that says they can’t do this. Does anyone have advice on this or where to begin.
 
Medicare doesn't pay for preventive visits EXCEPT for one...the Initial Preventive visit within the first year of Medicare enrollment. They can certainly bill an E/M with an AWV (G0438/G0439) as long as documentation reflects the reason for the addition of the E/M code. Add modifier 25 to the E/M.

Hope that's helpful.
 
Medicare 2nd for G0439 and 99397

I have a provider who is wanting to bill patients that have Medicare 2nd with a Preventive 99XXX to the commercial ins that is primary and then 6 months later bill the AWV for Medicare. So that once the primary rejects the GXXXX then we would bill to Medicare for reimbursement. Can anyone tell me if they have ever heard of this being done and if they indeed did get both paid?
 
UHC advantage plan

UHC advantage plan states that they will pay for G0439 and a physical 99396 etc. Together on the same day by the same provider. They state that it is not the same. I am having a hard time with this, I realize they are some different but it seems like double billing to me. Thoughts??
 
With our Medicare Advantage patients we do see them for both their annual physical (9939-) and their Medicare Wellness (G0438/9), however, we try to space these at about 6 months apart. The criteria is very different between the two exams but billing them together on the same day does seem odd to me. Plus, that would entail quite a lengthy visit if the billing criteria is being followed correctly. Hope that helps.
 
Dont forget Medicare Advantage

Medicare Advantage pays for both the AWV and the 99397 but not on same day and 99397 needs the Z code dx. How could UHC justify same day? They both have some similar components, doesn't make much sense to me.
 
wilccm said:
Can these be billed together. The way I understand it; both of these codes are wellness codes and we should only bill 1.
Click to expand...
Medicare will not accept AWV and preventive together even if the document supports. However, UHC Medicare is accepting AWV & Preventive on same day by same PCP, as long as the components of both are documented. No need to append 25 modifier to either of these. Hope this helps...
 
So... I have a provider that is billing for G0439, 99397, and 99214 on the same day. Pt has a Medicare Advantage plan. I have a separate note for the AWV, but with the new coding guidelines how do you distinguish if the main note qualifies for both the preventive med visit and problem visit?
 
ltskiver@gmail.com said:
UHC advantage plan

UHC advantage plan states that they will pay for G0439 and a physical 99396 etc. Together on the same day by the same provider. They state that it is not the same. I am having a hard time with this, I realize they are some different but it seems like double billing to me. Thoughts??
Click to expand...
One is "hands off", the G0439, it's for documenting all chronic conditions, reviewing other things like an advance directive annually etc. The Physical exam is the "hands on" portion, only covered by MA plans not traditional Medicare, checking vitals, listing to heart and lungs, etc.
 
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