Wiki G0439 for patient age below 65?

[lorettac]

Hello

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!

 

[espressoguy]

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.

 

[lorettac]

Thank you Expressoguy!