Tag Archives: G0438
Posted on 03. Feb, 2011 by dchandhok.
Stop worrying if your claims were denied, you still hold a chance as many carriers are reprocessing.
Almost a year ago, practices were told that Medicare will cover an annual wellness visit (AWV) for Part B beneficiaries effective Jan. 1 and last month, CMS announced the new codes for the AWVs. Everything seemed to look perfect until came the time for claims submissions and came the denials along with it.
The MACs may have hit a few speedbumps while processing the first of the AWV claims, but are attempting to get their systems rolling smoothly as January closes out for codes G0438 (Annual wellness visit, initial) and G0439 (Annual wellness visit, subsequent). We give you answers to several questions — straight from the MACs themselves — which may help you ensure that your claims go through smoothly.
Which Diagnosis Code Should You Use?
Several subscribers have told the Insider that they submitted their AWV claims using
Posted on 18. Jan, 2011 by dchandhok.
The Affordable Care Act (ACA) extended preventive coverage to more than 88 million patients covered by health insurance, and Medicare has codified that benefit in the form of an annual wellness visit. Medicare valued the new annual wellness codes based on a level 4, problem-oriented new and established E/M service. The two new codes are:
- G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
- G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.
Tip 1: Apply G0438 to Second Year of Coverage
Be wary of applying these codes to new Medicare patients coming in to your physician’s practice in 2011.
The reason is that Medicare will only reimburse the
Posted on 05. Jan, 2011 by jennifer.godreau.
One element that physicians cheered in the new Medicare annual wellness exam has been eliminated and another that beneficiaries demanded will be delayed.
Bowing to Republican pressure, the White House agreed to cut the voluntary after care planning that was listed as an option in G0438 and G0439. In addition, Rural Health Clinics will need to
Posted on 07. Dec, 2010 by jennifer.godreau.
Medicare beneficiaries will be thrilled that Medicare will cover annual well checks.
The Center for Medicare introduces a new benefit of wellness visits for beneficiaries annually, except during the year of their Welcome to Medicare exam. You’ll use two HCPCS level II codes to represent the new annual wellness visits, as follows:
G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
G0439 – Annual wellness visit; includes a personalized prevention plan of service (PPPS); subsequent visit
Medicare crosswalked the RVUs of 2.43 from new patient office visit code 99204 to G0438, and the RVUs of 1.50 from established patient office visit code 99214 to G0439.
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Posted on 09. Nov, 2010 by jennifer.godreau.
Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. “The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217,” notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in the Federal Register that will be published on Nov. 29. This amounts to a dismal 30 percent cut compared to the current rate of $36.8729.
Plus: If you perform a procedure that meets CMS’s description of an annual wellness visit, you should not report a code from CMS’s preventive medicine section to your Part B carrier, the Final Rule indicates. CMS does not pay for preventive medicine services billed under 99381-99397. Instead, report one of the following newly-established HCPCS codes:
- G0438 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), first visit
- G0439 — Annual wellness visit; includes a personalized prevention plan of service (PPPS), subsequent visit.
Get this: Some specialties will be facing cuts of up to 14 percent next year on top of the fee schedule cuts mentioned above. For the full story on the Fee Schedule changes and an analysis of how it affects the various specialites, check out Part B Insider.