Wiki Medicare codes

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rogerandpaula@mchsi.com

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I am a new coder at my first coding job at a family practice. Per Medicare, as of April 1, 2015 we can no longer use code 99387/99397 for the annual wellness visit for over 65 patients, instead now we can only use G0438/G0439. My question is this: Does this apply to straight Medicare patients only or do I use this code for those patients with medicare replacements such as Humana Gold, Coventry Advantra, AARP medicare complete, Secure Horizons, etc also? Please advise as I am confused and the biller in my office is telling me that I have to use the G codes for the medicare replacements also. I am coding in Missouri.

Thanks,
Paula
 
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In my experience the MA plans go with Medicare guidelines (specifically Humana). But as with any codes you would want to contact the payer and find out about their rules. Hope this helps you !
 
The G codes have been in effect for several years now. When I was in primary care I believe all but one of the Medicare Advantage plans accepted the G codes (Universal, maybe?). Also, be mindful of the pelvic exam code, which is entirely different.

Oh how I miss primary care coding :)

<sarcasm>

Lena
 
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