Friday, January 7, 2011

Medicare will cover physical exam code - G0438, G0439

Effective 2011, Medicare would cover for physical examinations and below are the two new codes. Please have this updated in the respective software and fee schedule.

New CPT codes to report Annual Wellness Visit (only for Medicare)

G0438 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit, (Short descriptor – Annual wellness first)

G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit, (Short descriptor – Annual wellness subseq)

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1 comments:

ellen duerr said...

DID you know that Medicare is holding all annual wellness exams(a least at First Coast Service Options) till after Monday April 4, 2011. It will be rejected and I got this directly for medicare.fsco.com/processing_issues/195964.asp

March 15, 2011 at 12:27 PM

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download