Wiki well exams

[skeuhs@yahoo.com]

does anyone know what cpt codes we are suppose to use for the well exams for medicare and bcbs or the other insurance companies? we have been using the 99395-99397 but we are getting denials. do we use the g codes now and if so which ones will they pay? everything that i look at about this talks in circles. i really need to get this figured out. Thanks for any help.

 

[Kisalyn]

Medicare doesn't pay for routine physicals. Anthem Medicare just stopped offering these services this year. If your providers perform these then the patients will owe for the cost of the visit.

If your providers want to offer Medicare beneficiaries wellness visits, take a look at the "Welcome to Medicare" and "Medicare Annual Wellness Visits."

They have very specific criteria your providers will need to address to report these. The upside is the reimbursement is pretty good and there is no cost share to the patient.


G0402 - Welcome to Medicare, Initial Preventive Physical Exam (IPPE)
Once in lifetime within 12 months of enrollment

G0438 - Annual Wellness Visit (AWV) Initial
Once per lifetime and at least 12 months after 'Welcome to Medicare' if one was performed

G0439 - Annual Wellness Visit, subsequent
One visit every 12 months, at least 12 months after the AWV