Wiki Preventive Exams with Medicare Advantage Plans

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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
 
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.
 
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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