# G0439 and 99397



## wilccm

Can these be billed together.  The way I understand it;  both of these codes are wellness codes and we should only bill 1.


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## nc_coder

No you cannot bill the AWV with the preventive visit.  You can bill the AWV with a separate E/M.


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## dianacampbell

*one or the other*

Correct you can only bill one or the other (medicare annual wellness or a preventative examination). However if documentation supports it you can split bill the visit with a 99212 or 99213 with a modifier 25 attached. 

As long as if besides the Medicare Annual Wellness they were also treated for an additional/seperate problem during the visit that is thoroughly documented/supported.


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## Yeny5863

I need help. Can these be billed together? as when to check g0439 or 99397. what is the difference? the way I understand it; both codes are welfare codes and we only have to invoice 1.


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## CodingKing

Yeny5863 said:


> I need help. Can these be billed together? as when to check g0439 or 99397. what is the difference? the way I understand it; both codes are welfare codes and we only have to invoice 1.



99397 - Annual full hands on Physician exam, age appropriate counseling etc 
G0439 - AWV this is cognitive service, not hands on.


Medicare does not pay for 99397
What is included in G0439 is listed here  

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm7079.pdf


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## jhendrix08

Agreed. Medicare will pay for only ONE preventive exam but this needs to be done within the first year of Medicare enrollment...G0402. Once that time has passed, Medicare patients are no longer eligible for an annual preventive exam. This is when the Annual Wellness Visit comes into play...G0438 and G0439.


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## tylerkayla26

*g0438 and 99397*

Hello,
I have a provider that seen a patient and billed 99397 instead of Welcome to Medicare. Can the provider see the patient again within the year to do the Welcome to Medicare visit? 
Tricia


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## Pathos

Medicare will not accept 99397, since they created their own preventive visits in the shape and form of G0402 (IPPE - Welcome to Medicare), G0438 (Initial Annual Wellness Visit), and G0439 (Subsequent Annual Wellness Visit).
If the patient has a commercial insurance, then 99397 would probably work; but you will never get Medicare to pay your provider a penny for 99397.


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## SuzieQs

*AWV + Preventive + OV*

I have a provider that insists they can bill AWV with a Preventive with an EST OV. We know the preventive won’t be paid. My question is what would justify this? They keep stating the exam they are performing is more in detail than one they would do for an OV and the OV is justified by problems they encounter during the Preventive. I can’t find anything that says they can’t do this.  Does anyone have advice on this or where to begin.


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## jhendrix08

Medicare doesn't pay for preventive visits EXCEPT for one...the Initial Preventive visit within the first year of Medicare enrollment. They can certainly bill an E/M with an AWV (G0438/G0439) as long as documentation reflects the reason for the addition of the E/M code.  Add modifier 25 to the E/M. 

Hope that's helpful.


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## ldhcoder

*Medicare 2nd for G0439 and 99397*

I have a provider who is wanting to bill patients that have Medicare 2nd with a Preventive 99XXX to the commercial ins that is primary and then 6 months later bill the AWV for Medicare. So that once the primary rejects the GXXXX then we would bill to Medicare for reimbursement. Can anyone tell me if they have ever heard of this being done and if they indeed did get both paid?


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## ltskiver@gmail.com

*UHC advantage plan*

UHC advantage plan states that they will pay for G0439 and a physical 99396 etc. Together on the same day by the same provider.  They state that it is not the same.  I am having a hard time with this,  I realize they are some different but it seems like double billing to me.  Thoughts??


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## jhendrix08

With our Medicare Advantage patients we do see them for both their annual physical (9939-) and their Medicare Wellness (G0438/9), however, we try to space these at about 6 months apart.  The criteria is very different between the two exams but billing them together on the same day does seem odd to me. Plus, that would entail quite a lengthy visit if the billing criteria is being followed correctly. Hope that helps.


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## julesmit@live.com

*Dont forget Medicare Advantage*

Medicare Advantage pays for both the AWV and the 99397 but not on same day and 99397 needs the Z code dx. How could UHC justify same day? They both have some similar components, doesn't make much sense to me.


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