Yes, You Can Get Paid for Medication Management

Betsy Nicoletti, MS

Disclosures

April 30, 2019

In This Article

Avoid Billing Snafus for Medicare Visits

Question: We are a four-physician internal medicine and infectious diseases practice starting to bill for the Welcome to Medicare (initial preventative) visit (G0402) for Medicare Part B patients. We have three questions:

1. Can we bill G0402 if there was another physical billed within a year, before the patient was eligible for Medicare?

2. Can we use G0402 for secondary insurances? 

3. What is the timeframe between the initial preventive visit and the Medicare Annual Wellness Visit?

Answer: A patient is eligible for the Welcome to Medicare visit during the first year of enrollment. The timing of any physical during the prior year, when covered by a commercial insurance, doesn't affect the eligibility for the Welcome to Medicare visit. This service is paid at 100% by Medicare, without deductible or co-insurance, so it would not be billed to the secondary insurance.

After the patient has the Welcome to Medicare visit, they are eligible for the Initial Annual Wellness (G0438) visit after 11 full months have passed. If the patient is past the eligibility period for the Welcome to Medicare visit, bill the Initial Annual Wellness visit.

For example, a patient on Medicare for 3 years, who has never received the Welcome to Medicare visit would be billed with the Initial Wellness visit, since they are no longer eligible for the Welcome to Medicare visit. A patient is eligible for a Subsequent Annual Wellness visit (G0439) after 11 full months have passed since the Initial Wellness visit, and every year thereafter.

Here's a timeline example:

  • Patient enrolls in Medicare on April 1, 2019.

  • Patient is eligible for Welcome to Medicare Visit until March 31, 2020, and receives the visit on September 15, 2019.

  • Patient is eligible for the Initial Annual Wellness visit after 11 full months have passed, in September 2020, and receives it September 20, 2020.

  • Patient is eligible for a Subsequent Annual Wellness visit after 11 full months have passed, and every year after that.

Have a coding question? Send it in and it may be answered in a future column. (Please be sure to note your specialty in the text of the question.)

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