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99387 & 99397

  1. Default 99387 & 99397
    Medical Coding Books
    I have providers who see medicare patients for there annual check ups and they are using CPT codes 99387 or 99397 and medicare is not paying for the services. Should we be using the HCPCS codes G0438 & G0439?


  2. #2
    UT Dallas, TX Chapter
    Wink Medicare Wellness
    Yes, That is correct. Here is the MLN Matters for you to read that explains in detail when to use each one.

    MLN MattersĀ® Number: MM7079
    Related Change Request (CR) #: 7079
    Related CR Release Date: February 15, 2011
    Effective Date: January 1, 2011
    Related CR Transmittal #: R138BP and R2159CP
    Implementation Date: April 4, 2011

    Annual Wellness Visit (AWV), Including Personalized Prevention Plan
    Services (PPPS)

    Ami Andrews BSHA/HIT, CPC, CPC-P

  3. Default
    I disagree, Ami. The initial AWV G0438 and subsequent G0439 do not include a physical exam. The preventive medicine codes 9938X-9939X which include exams should be billed with GY modifier so secondary insurance will pick up, otherwise the patient is responsible for these services.

  4. #4
    the GY is not necessary since physicals are a statutory exclusion for medicare (no ABN needed either), they will deny as not covered regardless and if secondary has benefits for it they will pay it. If you have a GY modifier on it often Replacement plans or the secondary commercial payors will deny due to the GY modifier being on the charge.
    there is a big difference between the physical exam and the Wellness Visit though, so the documentation has to support what was done. It will also be denied if you use the wrong code for the Wellness Visit, so the first year they are eligible for Part B is for the Initial Preventative Exam, since they didnt have that until a few years ago they may or may not have had an IPPE but it doesnt matter as far as billing the initial Wellness Visit, and the subsequent Wellness Visits

    good luck to you

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