MEDICARE SCREENING SERVICE AT THE TIME OF COVERED E/M SERVICES
Medicare will reimburse separately for covered screening services (e.g., G0101, Q0091) when performed at the same encounter as a covered E/M service, such as a problem-oriented visit (codes 99201-99215). The level of E/M service reported is based solely on the evaluation of the problem.
Example : Covered problem-oriented visit reported with a screening pelvic examination (G0101) and collection of a screening Pap smear specimen (Q0091).
| Bill to : | CPT/HCPCS Code(s) | ICD-9 Code(s) | Charge |
| Medicare | 99213-25 | Problem diagnosis | $61.20 |
| G0101-GA | V76.2, V76.47, V76.49, or V15.89 | $34.60 | |
| Q0091-GA | V76.2, V76.47, V76.49, or V15.89 | $40.00 | |
| Patient | N/A | N/A | $135.80 |
The GA modifier indicates that an ABN has been signed. Modifier 25 indicates that the E/M service was significant and separately identifiable and not part of the pelvic examination or collection of the Pap smear.
The patient is not billed for her portion until Medicare has processed the claim. The diagnosis code for the patient’s problem, signs or symptoms should be linked to the E/M service (99213). The level of service for the E/M visit will depend on what was performed and documented.
