Wiki Medicare Advantage Plans and PE visits

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alester76

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Can anyone provide any assistance with Routine Physical Exam( 99396+) billing with Medicare Advantage plans? I have always been told that Medicare doesn't offer/reimburse for this service,yet now I have received 2 payer calls stating Medicare Adv. members have coverage for Annual Physical Exams. If so, does anyone know of the proper codes to use for the E/M?
 
Most advantage plans cover routine physicals just like commercial plans with the same codes. You would be hard pressed to find one that doesn't. Its one of the big selling points of Medicare advantage to cover things that regular Medicare does not.
 
Yes. Annual physicals are covered under the Medicare Advantage plans; use the same CPT codes as you would with a commercial plan. These patients also are entitled to the Medicare Annual Wellness Exam (G0438 & G0439), they can be done in the same calendar year as a regular physical. Hope this helps.
 
Medicare plans and PE

Where can I find documentation for showing these services can BOTH be billed each year?
 
It would be best to ask for this from a particular payer. For instance, I have something from United Healthcare saying that their Medicare Advantage patients can have a PE and and AWV in the same year. I think it would be hard to find documentation for all advantage plans across the board.
 
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