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G0439 and billing 93000

  1. Default G0439 and billing 93000
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    Does Medicare cover 93000 with the AWV G0439, if it is submitted with the same dx code Z00.00? We are getting denials and I want to be sure before I start telling AR to adjust as bundled per EOB. It seems all of the insurance companies are making the EKG inclusive to the PE. Only add modifier 59 if there was a problem and this is a distinct procedure.
    Thank you for any definitive answer.

  2. #2
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    Per NCD 20.15 its not covered for routine other than the initial welcome to medicare visit.

    There is no coverage for EKG services when rendered as a screening test or as part of a routine examination unless performed as part of the one-time, “Welcome to Medicare” preventive physical examination under section 611 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

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