Medicare Wellness Exams

Heard that 1-1-11 these will be be covered. Does anyone have any info on the codes we should use.

nothing official yet

CMS is very good about putting out notices. You can google "CMS preventive examination" once in a while to see if anything new.

Medicare covering Physicals in 2011

Medicare has not released the codes, the reimbursement rates or the specific details one has to meet to bill the codes. Expect them around the time they publish the fee schedule.

Charlene Endre-Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS
Administrator, North Scottsdale Family Medicine
Blog: www.charleneburgett.wordpress.com
LinkedIn: www.linkedin.com/in/charleneburgett

Medicare covering wellness exams in 2011

The proposed rule (released in June) did not give the codes. The final rule, to be released in Oct, will give the codes and finalized description. I'll write an article about the proposed wellness benefit, and post it in the next week.

The service, as it is being defined by Medicare, will look more like the welcome to medicare visit than a preventive service. It will require developing a plan for the patient's preventive services for the next 5-10 years (in writing, given to the patient I believe) as well as listing ALL of the providers they currently see.

There will be two of them: initial and subsequent. The initial will have the same RVUs a a 99204 and the subsequent as a 99214. A patient newly enrolled to Medicare won't be eligible for it until after one year. during that first year, you do a welcome to medicare visit.

That's my understanding from the reports. I've printed off the Federal Register pages to take with me and read when I'm on my way to Atlanta this week.

More work, less pay

At least 50% of my Medicare patients have 3 or more problems so no reason to use this code if I am getting reimbursed the same and doing more work. I will be anxious to see if I can bill this new type of visit and a 99214-25 visit on the same day if I address the medical problems and their "wellness."