Can you bill 99397 and G0439 together?
Asked by: Bernie McKenzie | Last update: March 17, 2025Score: 4.8/5 (51 votes)
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.
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.
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."
2024 Annual Wellness Visit (AWV) CPT Codes, Billing, and Reimbursements
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.
What is the modifier 25 on 99397?
When a preventative exam is performed, 99381-99397 and a person gets an immunization/hearing test/eye exam/etc... then a modifier 25 is put on the preventative exam code. When a person also has an abnormal finding and a 99212 would be appropriate, I understand to add this with a modifier 25.
Can modifier 25 be used with preventive services?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
Does Medicare AWV have to be 365 days apart?
The guidelines on the AWV show that Medicare will allow the service once per year. Is this a 365-day year or twelve calendar months? Medicare would look to verify that at least 11 full calendar months have passed since the last AWV.
How do you know when to bill for both preventive and added services?
If an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive/wellness visit, and the problem or abnormal finding is significant enough to require additional work to perform the key components of a problem- focused evaluation and management service, then the ...
Can you bill G0439 with 99497?
If advance care planning is provided as a Medicare preventive service on the same date as an annual wellness visit (G0438 or G0439), append modifier 33 to 99497 for the first 30 minutes and, if reported, 99498 for an additional 30 minutes.
What age is CPT code 99397?
The provider performs an established well–patient visit for a patient who is 65 years or older.
What is not covered in a Medicare annual wellness visit?
Medicare does not cover Annual Wellness Visits if they are used to discuss, plan, or alter treatment for pre-diagnosed chronic illnesses, including high cholesterol, high blood pressure, or arthritis.
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 are three services not covered by Medicare?
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
How often can G0439 be billed to Medicare?
That portion of the visit must be medically necessary and reasonable to treat the patient's illness or injury or to improve the functioning of a malformed body part. You can only bill G0438 or G0439 once in a 12-month period.
What is the difference between annual wellness visit and preventive visit?
The prevention plan includes a screening schedule for preventive services to help the patient maintain their health and prevent potential illnesses. An annual physical includes a wellness exam and a full physical exam including blood work, lab tests and vaccinations.
Do I have to wait 365 days for an annual physical?
This doesn't mean you have to see a provider during the same month every year. But in order for a wellness visit to be covered by insurance, the appointment must take place 12 months after the last one.
Can an RN perform an annual wellness visit?
Can a registered nurse perform the AWV? Yes, for billing purposes. However, registered nurses are not on the list of acceptable physician specialties for RA purposes.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
What is the CPT modifier for preventive services?
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 both modifier 25 and 57 together?
Both Major and Minor Surgeries on the Same Day When a decision for surgery includes both major and minor surgeries and is made the day of surgery, the E&M billed for the decision must have both modifier –57 and modifier –25 appended.
Can you bill 99397 to Medicare?
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.
How do you use modifier 25 with preventive visit?
Modifier 25 should always be attached to the E/M code. If provided with a preventive medicine visit, it should be attached to the office-based E/M code (99202–99215). The separately billed E/M service must meet documentation requirements for the code level selected.
What is included in a 99397?
CPT code 99397 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.