Can you bill G0439 with 99396?
Asked by: Prof. Eula Hoeger II | Last update: September 6, 2025Score: 4.6/5 (52 votes)
Can 99396 be billed to Medicare?
Original (traditional) Medicare does not cover CPT codes 99381-99397, because Medicare has its own wellness visits with their own “G” codes and requirements. As mentioned, some Medicare Advantage plans do cover the preventive medicine CPT codes in addition to Medicare wellness visits.
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.
What is the CPT code 99396 for an annual wellness visit?
CPT code 99396 signifies a comprehensive preventive medicine evaluation and management service for established patients.
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.
Billing and Coding for Health Psychologists
Can you bill 99396 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.
How do I code my Medicare annual wellness visit?
AWV Coding. The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans. It is important to remember that code G0438 is for the first AWV only.
What modifier is used for 99396?
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 an annual physical the same as an AWV?
While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.
What is the CPT code for pediatric annual wellness visit?
For children ages 1 to 4 (early childhood), use CPT code 99382. For children ages 5 to 11 (late childhood), use CPT code 99383. For children ages 12 to 17 (adolescent), use CPT code 99384.
How long can you wait to use G0439?
You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don't bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient.
Can you bill a preventive visit with an office visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
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 you bill 99215 and 99396 together?
When billing 99215 with 99396, do both codes need modifier 25? Yes, We need to append modifier 25 to 99215. But do remember that the service should be separately identifiable E&M service was provided by the same physician on the same day as the preventive medicine service.
How to bill Medicare for an annual gyn exam?
- G0403 for the Initial Preventive Physical Exam (IPPE).
- G0438 for the first Annual Wellness Visit (AWV).
- G0439 for subsequent AWVs.
- G0101 for cervical or vaginal cancer screening and clinical breast exams.
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.
Can 99397 and G0439 be billed 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 difference between a preventive visit and a wellness visit?
Preventive care is things like getting your yearly check ups, your vaccinations, things like that to keep you from getting sick. And then wellness care would be like, "I'm sick I should go to the doctor now."
Do UnitedHealthcare wellness visits need to be 12 months apart?
The annual wellness visit is covered once every calendar year. Visits don't need to be 12 months apart. Visits do not include lab tests, drugs, radiological diagnostic tests or non-radiological diagnostic tests. Additional applicable cost-share may apply to any lab or diagnostic testing performed during the visit.
What are the guidelines for 99396?
What are the billing guidelines for CPT Code 99396? The billing guidelines for CPT Code 99396 include documenting medical necessity, accurately documenting the time spent during the visit, using appropriate modifiers for separate services, and obtaining consent or advance beneficiary notice (ABN) if applicable.
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 included in G0439?
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.
What is required for a Medicare annual wellness visit?
Do I need to do anything before my annual wellness visit? Yes. You should complete a "health risk assessment," a questionnaire that will be available in your MyChart account 14 days before your appointment. If we don't see your finished assessment in MyChart, we will call you to complete it.
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.
How much does Medicare pay for G0439?
SUBSEQUENT ANNUAL WELLNESS VISIT (G0439)
Patients are eligible for this benefit every year after their Initial Annual Wellness Visit. The reimbursement is around $117.