Wiki Medicare Wellness

[CoderKathy66]

Patient with MRP plan came in for Medicare Wellness, Physical and complaint that warranted an xray. Do I need a modifier 59 on G0439?

G0439
99397
99213-25
73030-RT

 

[CBLENNIE]

Medicare doesn't cover the preventative care E&M codes in ranges 9938x & 9939x, so your 99397 is not going to be covered. Also, modifier 59 is not appropriate for G0439 as it is a provider visit (technically it isn't an E&M but it is considered the same for modifier 25 & 59 purposes. You shouldn't require any modifier for G0439 since it is a column 1 code to code 99213 which you already have the 25 modifier appended to.

 

[CoderKathy66]

Thank you. We have claims with an MRP that will pay 99397. The 99213 is hitting against G0439.

 

[CoderKathy66]

Thank you. We have claims with an MRP that will pay 99397. The 99213 is hitting against G0439.

Also, We have been appending Mod 59 to G0402 when immunizations are given. It’s the only way it will get paid. ‘Shrug’