Wiki Billing a non covered service to secondary payer

[CFINDLING]

If a patient has Medicare and Medicaid, can a preventive exam (9938x-9939x) be performed and billed to Medicaid without billing to Medicare first since it is a non covered service by Medicare?

 

[tyrunyan1974@gmail.com]

no, medicaid will require an EOB from the Primary payer. Though Medicare should pay for a preventive annual exam you would just have to use the correct HCPC code to be paid.

https://www.cms.gov/Medicare/Preven...e-services/MPS-QuickReferenceChart-1.html#AWV

 

[CFINDLING]

Medicare will pay for an Annual Wellness Visit, yes. Those are paid at 100% with no co insurance due by the patient or a secondary payer. But that is different than a preventive exam (9938x or 9939x) which is what I am specifically asking about. A preventive annual exam is statutorily non covered by Medicare. Can that service then be provided to the Medicare patient anyway and billed to Medicaid only?

 

[Chelle-Lynn]

It would depend on the State you are billing in. In California there is an exception for this type of situation, but it may not apply to your specific carrier.