Results 1 to 3 of 3

Preventive Exams with Medicare Advantage Plans

  1. Unhappy Preventive Exams with Medicare Advantage Plans
    Medical Coding Books
    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

  2. Red face
    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.

  3. #3
    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.
    Last edited by CodingKing; 12-06-2018 at 01:52 PM.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

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

Similar Threads

  1. Replies: 5
    Last Post: 01-11-2018, 08:08 AM
  2. ABN for Medicare Advantage Plans
    By Lorisvg in forum Billing/Reimbursement
    Replies: 1
    Last Post: 01-24-2015, 09:01 PM
  3. Billing Well Woman exams to Medicare Advantage Plans
    By ohiocoder2013 in forum OB/GYN
    Replies: 1
    Last Post: 11-19-2014, 07:20 AM
  4. Medicare advantage plans lab
    By CRC CPC in forum Internal Medicine
    Replies: 2
    Last Post: 07-02-2013, 02:20 PM
  5. Medicare Advantage plans
    By khendricks in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-07-2013, 11:23 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.