Can we code G0439 and 99397 together?
Asked by: Prof. Maximilian Gibson DVM | Last update: September 8, 2025Score: 4.6/5 (74 votes)
Can you bill 99397 and G0439 together?
Don't bill CPT codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for Medicare services covered by HCPCS codes G0402, G0438, and G0439.
Can an office visit and preventive visit be billed together?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.
Does Medicare accept CPT 99397?
For example, a 67-year-old established patient presents for a covered service, such as an office visit for a chronic illness (e.g., 99213). At the same encounter, the patient chooses to receive a preventive medicine examination (e.g., 99397), which is a non-covered service under Medicare.
What codes can be billed with G0439?
HCPCS G0439 is used to code all subsequent Medicare annual wellness visits that occur after the initial AWV (G0438). So, if used correctly, G0439 would not be used until G0402 was used to code the IPPE and G0438 was used to code the initial AWV.
2023 Annual Wellness Visits (AWV) CPT Codes, Billing, and Reimbursements
Do you need modifier 25 with G0439?
Along with HCPCS G0438 or HCPCS G0439, CPT code modifier -25 must be appended to the medically necessary E&M service. CPT guidelines define the -25 modifier as "Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service."
What age is CPT code 99397?
The provider performs an established well–patient visit for a patient who is 65 years or older.
Can you bill a preventive visit to Medicare?
Requirements and components for G0402 include: Billable for the IPPE only. Patients are only eligible if they are in their first 12 months of Medicare Part B coverage. Medicare pays for one IPPE per beneficiary, per lifetime.
Can you bill 99397 and G0101 together?
Do not bill HCPCS code G0101 in addition to a preventive service reported with CPT® codes 99381—99397.
What is a gy modifier?
GY modifier is added to claims in which the item or service is statutorily excluded, does not meet the definition of any Medicare benefit. Correct Use. Append when services are provided under statutory exclusion from Medicare Program. It is not necessary to provide patient with an ABN for these situations.
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Is a wellness visit the same as a preventive visit?
Medicare's Annual Wellness Visits (AWV) are annual preventive visits for patients to create or update a personalized prevention plan. These preventative visits are designed to let the patient explain to their provider how they feel about their health status by filling out a health risk assessment.
Can 2 office visits be billed same day?
Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.
Can office visit and preventive visit be billed together?
Can Office and Preventive Visits be Billed Together? The short answer is yes. CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients.
Can 99397 be billed as telehealth?
Providers may only bill one preventive medicine code (99381-99387, 99391-99397) to cover both the portion done via telehealth and any necessary face-to-face interaction associated with the preventive care service. Codes for diagnostic services may be separately billed per standard coding guidelines.
What is the difference between AWV and annual physical?
An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure.
Can you bill 99397 and G0439 in the same year?
These codes must be used for these services for Medicare beneficiaries. CPT codes 99381-99397 for comprehensive preventive medicine evaluation and management services should not be used to bill for Medicare services covered by HCPCS codes G0402, G0438 and G0439.
Is CPT code 99397 covered by Medicare?
Traditional Medicare does not pay for routine services reported with codes 99381-99397.
Do Medicare wellness visits need to be 12 months apart?
Medicare provides coverage of an Annual Wellness Visit (AWV) for a beneficiary who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period and who has not received either an Initial Preventive Physical Exam (IPPE) or an AWV within the past 12 months.
Can you bill 99214 and G0439 together?
Medicare does discourage this and says there is too much 'crossover' between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
Can you bill an AWV and E&M together?
The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.
What does G0439 include?
HCPCS code G0439 for Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit as maintained by CMS falls under Counseling, Screening, and Prevention Services.
How to code a preventive visit?
Preventive visit codes 99381-99397 include “counseling/anticipatory guidance/risk factor reduction interventions,” according to CPT. However, when such counseling is provided as part of a separate problem-oriented encounter, it may be billed using preventive medicine codes 99401-99409.
Can you bill a procedure and office visit together?
The immediately preceding evaluation that leads to the recommendation of an office procedure can be billed on the same day as the procedure itself. Similarly, counseling and MDM that arise from the results of a procedure may take place immediately following it and are separately billable.