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Thread: Medicare Annuals

  1. #1

    Default Medicare Annuals

    AAPC: Back to School
    I have a question reguarding our Traditional Medicare patients and their annual exams. I understand that Medicare will only allow 1 pelvic/breast & pap (G0101 & Q0091) per 2 years unless the patient is considered "high risk". Our physicians feel that it is important to follow up with our patients on a yearly basis. They perform a pelvic/breast exam as well as a Hemmocult test each year. If our patient does not qualify as "high risk" by Medicare, how should we bill the off year? Would we simply be billing a 99214 (or appropriated e/m level) and G0328? This is how the office previously was billing for these services. I am new to this office as well as the billing/coding for OB/GYN. I just want to make sure we are doing things appropriatly.

  2. #2
    Join Date
    Apr 2007


    We still bill for the G0101 and Q0091 (if smear done) but get an ABN signed. The patient is responsible since it is the "off" year by Medicare guidelines.

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