Wiki Medicare Gyne visit/preventative


Local Chapter Officer
Beloit, WI
Best answers
I need some facts please: I attented an ACOG seminar with my physician and we were told by the speaker that the physician can charge an Gyne visit
G0101 and the Q0091 for gyne part of the visit and also a preventative if the physician is doing a complete checkup with no other problems.

I am aware of a gyne visit and a problem E&M on the same date but I was not aware of this gyne visit with a preventative because medicare never pays for a preventative and the expense would be the patients responsibility. Are any of you doing this?

thanks in advance
Sheila Sweetland,CPC
You can bill the G0101, the Q0091 and an E/M service 99201-99215 with a 25modifier to Medicare when performing the pap, pelvic and breast exams on a Medicare patient who has a problem when your physician documents correctly. You can bill Medicare for the G0101 and the Q0091 for the pap/pelvic and breast exams and bill the patient a carved out rate (Your charge for a preventative exam minus Medicare's allowed amounts for the G0101 and Q0091 codes) for the preventative portion of the "well woman" exam. If you are going to bill the patient I would inform them of this ahead of time as you do not want upset patients. You do not need an ABN signed for the preventative exam because Medicare never covers the preventative codes. I wouldn't bill the G0101, the Q0091, an E/M and the preventative codes all together.

We do bill our patients for the carved out fee of the preventative exam.
Yes, you can

If it was scheduled as a preventive exam, then you must use the CPT preventive exam code according to CMS, along with the G0101 and Q0091, carving out the value of the HCPCS codes from the preventive exam charge. If a problem was addressed during the same visit, and there is enough documentation relating only to that problem to satisfy the requirements of an E/M (99201-99215), then you can assign that as a fourth code with modifier 25. It's all about documentation.