I have a doctor that sees patients in their home and does AWV G0439 and 99349 Home Visit. Medicare RR is denying 96160 for pos12. Is this not allowed? I cannot find any info to confirm this denial. Please help.
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Wiki POS 12 for 96160
- Thread starter alison.sparks@galenmedical.com
- Start date
SharonCollachi
Guest
From AAFP
Health risk assessments
Two new CPT codes may be used to report health risk assessments:
You may bill this service if the instrument was administered and scored in a diagnostic setting in conjunction with an office visit. You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. For Medicare purposes, you also should not bill 96160 separately if furnished as a preventive service, because at that point it would describe a non-covered Medicare service.
For 96161, submit the claim using the patient's beneficiary information, and be sure the health risk assessment documentation resides in the patient's chart, not the caregiver's, because the service is being delivered on behalf of the Medicare beneficiary. Medicare plans to pay an average of $4.67 for codes 96160 and 96161.
Health risk assessments
Two new CPT codes may be used to report health risk assessments:
- 96160, “Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument,”
- 96161, “Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument.”
You may bill this service if the instrument was administered and scored in a diagnostic setting in conjunction with an office visit. You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. For Medicare purposes, you also should not bill 96160 separately if furnished as a preventive service, because at that point it would describe a non-covered Medicare service.
For 96161, submit the claim using the patient's beneficiary information, and be sure the health risk assessment documentation resides in the patient's chart, not the caregiver's, because the service is being delivered on behalf of the Medicare beneficiary. Medicare plans to pay an average of $4.67 for codes 96160 and 96161.