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Wiki Medicare Wellness Visits

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lbpeterson

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Raynham, MA
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I have a question... I'm hoping to get some insight on providers billing IPPE/AWV's AND Evaluation and Management codes (99201-99215). A provider had attended a presentation that stated providers can bill G0402, G0438, or G0439 with 99201-99215 for chronic stable conditions.

However, I am not comfortable relaying this message to my providers without some evidence.

Does anyone have a link that will clarify this for me? I was unsuccessful on the CMS website.

I would appreciate it!
 
While this answer doesn't specify "stable chronic conditions", the Preventative Services FAQ's on the CMS site does address billing an E/M service with the AWV. Here is the verbatim answer:

"Medicare payment can be made for a significant, separately identifiable medically necessary E/M service (Current Procedural Terminology [CPT] codes 99201-99215) billed at the same visit as the IPPE when billed with modifier-25. That portion of the visit must be medically necessary to treat the beneficiary's illness or injury, or to improve the functioning of a malformed body member.
(FAQ3357) "

Here is the link:

https://questions.cms.gov/faq.php?id=5005&faqId=3357
 
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