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Thread: Medicare question

  1. #1

    Default Medicare question

    AAPC: Back to School
    Does Medicare ever pay for 99397 PE with a v-code or does it always go to the patient? I'm not sure how to code a physical 65 and up with no pelvic exam. The patient also had an ov with dx and ear flush.

  2. #2
    Join Date
    Apr 2007
    north seattle wa

    Default PE

    Medicare doesn't pay for routine services. The only pay for the Welcome to Medicare physical and there are criteria that have to be met to bill it.

  3. #3
    Join Date
    Apr 2007
    San Gabriel Valley

    Default preventive

    you could code the preventive but it will be patient responsiblilty. you can code the Q0091 with V76.2 for the pap and G0101 for the breast and pelvic. If patient is presenting with a problem you can use the E/M level but only link the problem dx to the E/M and not the V codes also use modifer 25 to the E/M

  4. #4
    Join Date
    Apr 2007
    San Gabriel Valley


    sorry forgot to give you the Dx for the G0101 V72.32.

    2009 a new code that was replaced the code for 2008 is the welcome to medicare , for 2009 HCPCS code G0402 is for the medicare bene's new to Medicare that have not had a preventive within the enrollment for the 1st 12 month of enrollment. Medicare will pay for that one it is considered IPPE. But remember to check the benefits if they had one somewhere else, or else you will have to bill the patient or eat the cost.

  5. #5


    Thanks so much! Thats what I needed!

  6. #6
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire

    Default Medicare

    If the pt came in for a Routine PE 99397 and ear wax removal by the MD 69210, I would put GY and 25 on the PE. Subtract the cost of ear wax rmvl from the Physical and this is what the pt would pay. IPPE has many facets to truly charge for that.
    Last edited by kbarron; 02-02-2009 at 07:27 AM. Reason: fixed key punch error
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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