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Thread: Yearly exam

  1. #1
    Join Date
    Apr 2007
    Oklahoma City

    Default Yearly exam

    AAPC: Back to School
    What code is correct for the yearly exam of a patient that has had Medicare for over a year?

    Urgent Care

  2. #2
    Join Date
    Apr 2007
    North Carolina


    G0402 (Welcome to Medicare PE) must be performed within 1 year of the patient's enrollment into Medicare. If the exam is performed after 1 year of the enrollment date, this is a non-covered service and billable to the patient.

    A preventive medicine service (CPT codes 99381-99397) is a noncovered service. The physician may charge the beneficiary, as a charge for the noncovered remainder of the service, the amount by which the physician's current established charge for the preventive medicine service exceeds his/her current established charge for the covered visit. Pay for the covered visit based on the lesser of the fee schedule amount or the physician's actual charge for the visit. The physician is not required to give the beneficiary written advance notice of noncoverage of the part of the visit that constitutes a routine preventive visit. However, the physician is responsible for notifying the patient in advance of his/her liability for the charges for services that are not medically necessary to treat the illness or injury.

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