Medicare Welcome Exam
According to the Medicare website the welcome exam can be billed only within the first 12 months the patient's Medicare coverage is active. Attached is information I obtained from their website hope it helps in your billing follow up of this claim. Frequent asked questions is where you may find the answer to your question. Hope it helps.
www.cms.gov - medicare welcome exam
Frequently Asked Questions
Who may perform the IPPE?
Either a physician (a doctor of medicine or osteopathy) or a qualified non-physician practitioner
(a physician assistant, nurse practitioner, or certified clinical nurse specialist) must furnish the IPPE. Is the IPPE the same as a beneficiary's yearly physical?
No, the
IPPE
is not a
“routine physical checkup” that
some seniors may receive every year or two from
their physician or other qualified non-physician practitioner. For a newly enrolled beneficiary, the
IPPE
is an
introduction to Medicare and covered benefits, and focuses on health promotion and disease prevention and detection to help beneficiaries stay well. Medicare does not cover routine physical examinations.
Are clinical laboratory tests part of the IPPE?
No, the
IPPE does not include any clinical laboratory tests, but you may want to make referrals for such tests as part of the
IPPE,
if appropriate.
Do deductible or coinsurance/copayment apply for the
IPPE?
No, coverage for the
IPPE
is provided as a Medicare Part B benefit. Medicare waives both the
coinsurance or copayment and the Medicare Part B deductible for the
IPPE
(HCPCS code G0402).
Neither is waived for the screening EKG
(HCPCS codes G0403, G0404, or G0405).
If a beneficiary enrolled in Medicare in 2011, can he or she have the
IPPE
in 2012 if it was not
performed in 2011?
A beneficiary, who has not yet had an
IPPE
and whose initial enrollment in Medicare Part B began in
2011, is eligible for an
IPPE
in 2012, as long as it is done within 12 months of the
beneficiary's
first
Medicare Part B enrollment effective date.
Can I bill a separate Evaluation and Management (E/M) service at the same visit as the
IPPE?
Medicare may pay for a significant, separately identifiable medically necessary E/M service (Current Procedural Terminology [CPT] codes 99201 – 99215) billed at the same time as the
IPPE
when billed
with modifier
-25
. That portion of the visit must be medically necessary to treat the
beneficiary's
illness
or injury, or to improve the functioning of a malformed body member.
Which diagnosis code should I use for the
IPPE?
You must report a diagnosis code; however, the Centers for Medicare & Medicaid Services
(CMS)
does not require a specific diagnosis code for the
IPPE.
Therefore, you may choose any appropriate
diagnosis code.
CPT