What codes can be billed with G0439?
Asked by: Dangelo Jacobs III | Last update: April 4, 2025Score: 4.5/5 (57 votes)
What modifiers can be used 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 are possible AWV codes?
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.
Can 99214 be billed with G0439?
The AWV is billed with two codes, G0438 and G0439, which are based on relative value units (RVUs) for 99204 and 99214 respectively. Bill G0438 for a patient's first-ever AWV, and G0439 for each subsequent AWV which a patient may receive the rest of his or her life.
When can G0439 be billed?
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.
2024 Annual Wellness Visit (AWV) CPT Codes, Billing, and Reimbursements
What diagnosis code to use 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.
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 a G0439 and an 99397 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 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 is a 25 modifier used for in medical billing?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
How do I code my Medicare wellness visit?
- G0402: This code applies to the Welcome to Medicare visit — also referred to as an Initial Preventive Physical Exam (IPPE). ...
- G0438: After 12 months of being enrolled in Medicare, a patient becomes eligible for their initial Annual Wellness Visit.
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.
What CPT codes are considered preventive?
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.
Is G0439 a once in a lifetime code?
First annual wellness visit (only one initial AWV per beneficiary per lifetime).
What are the three words to remember for a Medicare wellness exam?
Word recollection (Banana, Sunrise, Chair) Have patient repeat the 3 words, tell them to remember them.
Is bloodwork part of a wellness visit?
Does a Wellness Exam Include Blood Work? Yes, a wellness exam can include blood work. However, it's important to note that the specific tests conducted during a wellness exam may vary from person to person.
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.
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.
Can you bill 99213 and 90833?
CPT codes 90833, 90836, and 90838 are add-on codes that can only be used with E/M codes 99203-99205 (for new patients) and 99213-99215 (for existing patients). You can use these codes when you provide psychotherapy in addition to an evaluation or management appointment.
Can G0439 be billed with 99214?
The physician documents her significant review of the patient's problems, bills for the annual wellness visit with code G0439, and adds a 99214 E/M code because she addressed two stable chronic illnesses and performed prescription drug management. She adds modifier 25 to the E/M code.
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.
Can G0439 be billed as telehealth?
Note that G-codes G9481–G9485 should be used for all telehealth services delivered in the home; the one exception is annual wellness visits, which should be billed using G0438 or G0439. No other G-codes or CPT codes should appear on the claim line for telehealth services delivered in the home.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
What are the three types of Medicare wellness visits?
- Initial Preventive Physical Exam (IPPE)
- Initial Annual Wellness Visit (AWV)
- Subsequent AWVs.
What is the CPT code for Medicare annual wellness visit?
Understanding the billing codes for Medicare Annual Wellness Visits (AWVs) can provide a better idea of what is expected, both by the patient and by the payer. Understanding billing codes may also help you project revenues and optimize your staff's capacity.