Wiki G0439 for patient age below 65?


Miramar, FL
Best answers

We have a patient is who age 52 but qualifies for Medicare through his disability; he came to office for yearly physical. At first, we submitted claim to Medicare with 99396, received denial due to not a payable code with Medicare. Then corrected claim and resubmitted with G0439 but Medicare denial it again. :(

Appreciated if someone could advise the correct code for submission, please!

Thank you very much!
There are 3 Medicare Wellness Visits.

G0402 - Welcome to Medicare - must be done during the first year of Medicare eligibility.
G0438 - Annual Wellness Visit, Initial
G0439 - Annual Wellness Visit, Subsequent

If the patient has not previously had a G0438, I believe the G0439 will deny.

Also, there are some specific things that need to be addressed during a Medicare Wellness Visit that generally aren't addressed during a routine physical. You can't automatically rebill a routine physical as a Medicare Wellness Visit, just because Medicare denied the physical.