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Wellness and Carve-out Rules

  1. #1
    Question Wellness and Carve-out Rules
    Medical Coding Books
    Does anyone have an opinion or know of any guideline that has been placed regarding Medicare's coverage of annual physicals and our mandatory carve-out rule? Currently if a patient is seen for an annual and a significantly separately identifiable E/M is performed at the same time, we are instructed to carve-out Medicare's allowed amount for the E/M out of the Preventive Medicine Service. For example, 99397 $300, 99214 $97. We would substract the $97 from the $300 and the patient would be responsible for the difference. Since Medicare is going to start covering the 99397 once a year, does anyone think this carve-out rule will change or remain the same?

    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  2. #2
    Default Medicare carve out rules
    Please let me know where you've received information regarding the coverage of preventative care services for Medicare patients. Our organization is having a very difficult time determining the proper procedures to follow regarding preventative care (99381-99397) because it is presently not covered. We are continually receiving instruction to manipulate the billing to minor complaints that are really not significant and my instruction has always been to determine if the visit is primarily (more than 50%) for preventative and to code it that way.

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