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Billing E&M Service w/G0101

  1. Default Billing E&M Service w/G0101
    Medical Coding Books
    I work for a Family Medicine Practictioner who wants to bill G0101 separate from a routine physical. So my question is do codes 99381-99397 include the cervical and vaginal screenings (G0101) or can this be billed separately?
    Any advice would be helpful.

  2. Default
    99381-99397 is not a covered service by Medicare, but it can be billed. The patient would more than likely be responsible for the amount unless the patient is covered by a secondary carrier that will pay it. When billing you would have to subtract the amount of the G code fee from the wellness code fee and use modifier 52 and GY with the E/M code. Modifier 52 indicates the service was reduced and GY indicates the services is not covered by Medicare.

  3. #3
    I would not put the 52 modifier on the preventive med code. You aren't doing a lesser preventive service, just reducing the charges and that is per Medicare's guidelines. G0101 can be billed in addition to the preventive code and, if appropriate, Q0091 can also. The charge for each code is then subtracted from the billed charge for the prevent med code.

    Medicare allows this as a "benefit" for their members since it reduces the amount they will owe for the prevent med visit. Third party payers in our area don't reimburse those codes in addition to the prevent med visit so it would be good to know what kind of coverage you'd have in your area.

    WPS has a good article:
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  4. Default
    Would you add a 25 modifier to the E&M code if billing G0101 with a commercial insurance?
    Last edited by tlashawn1176; 01-20-2009 at 01:09 PM. Reason: misspelled word

  5. #5
    Wink Remember
    PLease remember Medicare does pay for the " WELCOME TO MEDICARE PHYSICAL EXAM"

    this physical must be done within 6 months of the part B active date.


  6. #6
    Default Ippe
    Quote Originally Posted by pricandime View Post
    PLease remember Medicare does pay for the " WELCOME TO MEDICARE PHYSICAL EXAM"

    this physical must be done within 6 months of the part B active date.

    That changed this year didn't it? I believe it's one year from active date.

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