Preventive Exams with Medicare Advantage Plans

alester76

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Can anyone please assist me with proper coding for a Preventive Exam for Medicare Advantage/Medicare +Blue plans?

I am being told that a preventive visit is covered, as in 99396 or 99397 but I cannot get claims to scrub with these codes. Just recently I have started getting rejections and / or patients being billed for these visits. Plan states there is a preventive code but they wouldn't give it to me.

Please help!..Thanks so much
 
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We bill Medicare and MCR Advantage plans the Annual Wellness Visit codes G0438 and G0439. We never use 99396 or 99397 for Medicare/MCR Advantage, because they are not a covered code.
 

CodingKing

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Most advantage plans pay for the annual physical codes in addition to the AWV. There services are not comparable or interchangeable so you cannot bill a full physical under AWV code and vice versa. AWV is a cognitive service, its not a hands on full physical like 99381-99397. It may need a modifier if performed on the same date.

Example from Anthem Blue Cross covers both this explains the difference.

https://www11.anthem.com/ca/shared/f2/s2/t1/pw_g329161.pdf
 
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