Wiki Medicare AWV with preventive visit

[jbhuju]

hello,
when we do Medicare Annual Wellness Visit(G0438/G0439) can we bill preventive visit (9939...) at the same time with modifier 25 on it? if yes what is the requirement for preventive visit? is there any certain number of physical exam elements must be meet?
please help. Thank you.

 

[AmandaBriggs]

Good morning,
CMS does not cover preventive visits (CPT 9939...). Please see this link that states this as well as discussing the preventive care that is covered by CMS:
MLN6775421 – Medicare Wellness Visits
Hope this helps.
Thanks,
Amanda

 

[jbhuju]

not bill to traditional medicare but for medicare advantage plan, can we bill? if yes what are requirements.

 

[AmandaBriggs]

Medicare Advantage plans follow Medicare guidance. You would have to review each MA plan's policies to determine if they consider a preventive visit a covered service.