What is G-code G0402?
Asked by: Ms. Megane Rodriguez | Last update: December 30, 2023Score: 4.5/5 (19 votes)
Coding procedure code G0402: Initial Preventive Physical Examination; face-to-face visit, services limited to a new patient during the first 12 months of Medicare enrollment.
What is procedure code G0402?
G0402. Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment. G0403. Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report.
What can you bill with G0402?
The four HCPCS codes used to report IPPE services and ECG screenings are: G0402 – IPPE is a face to face visit. Service is limited to a new beneficiary during the first 12 months of Medicare enrollment. G0403 – Electrocardiogram (ECG) performed as a screening for the IPPE (with interpretation and report)
Is G0402 covered by Medicare?
A - Medicare AWVs consist of three specific visit types statutorily covered by Medicare with no co-pay or deductible. They are the IPPE (the “Welcome to Medicare” visit, G0402), the initial AWV (G0438), and the subsequent AWV (G0439). These visits do not require a comprehensive physical exam.
How many times can G0402 be billed?
Claims for HCPCS code G0402- Initial Preventative Physical Examination (IPPE), may not be billed more than 12 months after the effective date of the beneficiary's first part B coverage, or more than once in a lifetime.
G-Code Lesson 1 What is G-Code?
Is the welcome to Medicare visit mandatory?
The Welcome to Medicare checkup is optional, but it serves as a baseline for monitoring your health during the annual wellness visits that Medicare will pay for in subsequent years.
What is the reimbursement rate for G0402?
WELCOME TO MEDICARE VISIT / IPPE (G0402)
This visit is offered to patients within 12 months after enrolling in Medicare. They can only receive this benefit once. The reimbursement is around $168.
Can G0402 be billed as telehealth?
The Initial and Subsequent Annual Wellness Visit Code G0438, G0439. The initial and subsequent wellness visit codes may be done via phone only. The Welcome to Medicare/Initial Preventive Physical Exam service, G0402, may not be done via telehealth, either with audio/visual or phone only.
Can you bill 99214 with G0402?
Expert. Yes it is acceptable to assign both codes, the documentation just needs to clearly support each service. The elements to support each code should "stand alone".
How do I bill a welcome to Medicare visit?
In addition to the primary annual wellness visit codes (G0402, G0438, and G0439), a select list of other codes may be billed for services performed during a Welcome to Medicare visit or AWV. When using any of these codes, a separate note is required to support each rendered service.
What does G0402 include?
Coding procedure code G0402: Initial Preventive Physical Examination; face-to-face visit, services limited to a new patient during the first 12 months of Medicare enrollment.
Why doesn t Medicare pay for annual physicals?
The difference between a Welcome to Medicare, Annual Wellness Visit, and a physical exam is that Medicare Part B won't cover a routine physical exam because it's not a Medicare preventative visit. It's diagnostic.
Can you bill the depression screening with the G0402?
The Depression screening is bundled and included in the charges for G0402 and G0438.
Can you bill G0402 and G0403 together?
Yes, you will need a modifier when reporting codes G0402 & G0403 together. While there is no CCI edit in place for the code pair, Medicare Claims Processing Manual instructions state that modifier 25 should be appended to an evaluation & management visit when performed with another significant procedure.
How often will Medicare pay for a physical exam?
While Medicare does not cover annual physical exams, it does cover a single "initial preventive physical examination," or IPPE, followed by exams called "annual wellness visits," or AWVs.
Can 99397 be billed with G0402?
Medicare will not accept 99397, since they created their own preventive visits in the shape and form of G0402 (IPPE - Welcome to Medicare), G0438 (Initial Annual Wellness Visit), and G0439 (Subsequent Annual Wellness Visit).
What is welcome to Medicare CPT code G0402?
Initial Preventative Physical Exam (IPPE) G0402 is Known as the “Welcome to Medicare Visit” to Most Medical Billers.
Can G0402 and 99497 be billed together?
A: Yes, and don't forget to append modifier 33, “Preventive service,” which will avoid out-of-pocket cost to the patient. ACP is an optional element of the Welcome to Medicare physical (G0402), so check your Medicare Part B contractor's payment policy before separately reporting 99497–99498 on the same date as G0402.
Does time have to be documented for G0442?
this is a time based code, so, the provider must document at least 8 minutes for the service in order to qualify for G0442.
Will Medicare continue to pay for telehealth in 2023?
Medicare telehealth coverage
Medicare's coverage of telehealth for outpatient services will largely remain the same after the Consolidated Appropriations Act of 2023 (CAA) extended many telehealth flexibilities through the end of 2024.
What is the difference between a Medicare wellness visit and an annual physical?
A physical exam helps your doctor figure out what the problem is and what needs to be done. When you're healthy and feeling good, you want to stay that way. A wellness exam helps your doctor understand what's working for you and how to best support your continued health and well-being.
How to document Medicare annual wellness visit?
- Health risk assessment. ...
- Medical and family history. ...
- Current providers and suppliers. ...
- Routine Measurements. ...
- Cognitive function. ...
- Potential risk factors for depression. ...
- Functional ability and safety. ...
- Written screening schedule.
How do I bill my annual 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 average reimbursement for remote patient monitoring?
CPT code 99454 covers 16 days of remote data monitoring in a rolling 30-day period. This code can be billed once every 30-days and is reimbursed $55.77 per patient per month.
What is the CPT code for annual visit?
An initial Annual Wellness Visit code is documented using G0438, subsequent Annual Wellness Visits are documented using code G0439. The Annual Routine Physical Exam allows members to seek a separate visit with their physician to discuss general health questions/issues without presenting a specific chief complaint.