Wiki Medicare AWV codes being billed to commercial insurance

[LYurovich]

We recently started billing for a new practice. They are billing G0438 and G0439 to non-Medicare aged patients that have commercial insurances. In most cases, the commercial insurances are paying. As far as I knew, this was a Medicare code and would only be reimbursed by Medicare & Medicare Advantage plans. Any information or insight would be appreciated. I did reach out to United HC on one of the claims and got a very vague response, so I'm still not convinced these are processing and paying correctly. Thanks in advance!

 

[csperoni]

Every commercial payor makes their own policy about whether or not to recognize and/or pay codes that are carrier discretion. Additionally, some provider contracts are different than others and what is paid for one provider could differ than what is paid for another. Only the payor and/or your specific contracts can tell you whether they are processing and paying correctly.