under age medicare patients

dmcopel@hotmail.com

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Charter Oak, IA
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I have a 52 year old medicare patient that came in our Doctors office for their yearly Medicare Physical what CPT code do I use for this??

They are not of Medicare age and previously when we used codes 99395-99396 Medicare won't pay because they are not of age, what do i do??
 

chmac

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Canton, OH
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When you are coding an annual wellness visit for a Medicare patient, the two codes you use are G0438 (initial visit, used once in a lifetime) and G0439 (subsequent) along with V70.0 as the primary diagnosis. The patient should be covered if they haven't had another initial wellness visit or annual wellness visit within the last 12 months.
 

teresabug

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Goodyear, AZ
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there are actually THREE medicare codes. If the patient is within their first year of medicare coverage, your provider will see the pt first for the "Welcome to Medicare" visit which is G0401. One year later, the pt is then seen for for the G0438, then a year later G0439 subsequently.

The doc requirements for these codes are on the cms.hhs.gov site and also on the MEDLEARN Matters site.
 

lgardner

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64
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Tucson, AZ
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I have a 52 year old medicare patient that came in our Doctors office for their yearly Medicare Physical what CPT code do I use for this??

They are not of Medicare age and previously when we used codes 99395-99396 Medicare won't pay because they are not of age, what do i do??

I don't think Medicare won't pay because the patient is "not of age", Medicare doesn't cover preventive visits at all (besides the WTM and AWVs).
 

teresabug

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Local Chapter Officer
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409
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Goodyear, AZ
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Medicare does not pay for preventive "exams" which involve touching (993XX series). If the patient wants a "physical" have them sign an ABN and pay for the service day of.
MCR AWV's are G0401, G0438 and G0439.
 

lgardner

Networker
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64
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Tucson, AZ
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I haven't seen an age restriction.

per CMS:
"Medicare covers an Annual Wellness Visit (AWV) providing Personalized Prevention Plan Services (PPPS) for beneficiaries who:
■■ Are not within the first 12 months of their first Medicare Part B coverage period; and
■■ Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months."

we bill these for patients under the age of 65 and I do not believe we've had any problems with this.
 

teresabug

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Local Chapter Officer
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409
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Goodyear, AZ
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they are not based on age. Anyone any age can be on Medicare due to disability, etc.
The initial welcome to medicare visit code G0401 also pays for screenings such as ekg, bone density, etc. These are G codes as well and can be billed when performed with the IPPE code G0401.
 

mrdave

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Yakima, WA
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Part "B" requirement

G0402 within first year of having part "B"
G0438 First visit after first year of having Part "B"
G0439 Subsequent visits not within one year of G0438 or G0439.
No personal age requirement.
 
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