Wiki medicare modifier

[genawaller]

Do we have to have a modifier to bill 99397 with DX V70.0?

 

[dclark7]

You do not even have to bill this to Medicare unless the patient requests it. Routine physicals are NOT covered by medicare period. If the patient requests this be sent to Medciare because they have a secondary insurance that will cover it and they need a denial from Medicare, and IF you obtained a voluntary ABN (which is not required since this code is statutorily excluded from coverage), you would use a GX modifier (Notice of liability issued, voluntary under payer policy).