Reimbursment for G0101

Hi

Would you please let me know how I can get paid for G0101 by United Health Care? as I am billing G0101 with 99214 on the same day and 99214 is paid but G0101 is denied as not seperately reimbursable. Can I use modifier 25 with this?
Please suggest me a solution.

Thanks

Muhammad Asif

out of luck

It is bundled into the preventive visit payment for all but Medicare. best solution- do not do a pap on the same day as an E&M visit, or bill the preventive visit and an E&M with -25; UHC may pay that, jst be sure your note addresses both preventive counseling and problem-oriented treatment.

G0101

G0101 is typically paid only by Medicare. (Q0091, obtaining and conveying a pap smear may be paid by commercial insurers.)

As signaturedoc says, the pelvic and breast exam is part of a preventive service, that is, it is part of an age/gender appropriate exam. Those codes are represented by 99381--99397.

There are a number of articles in the Codapedia about the preventive services. You can find them by entering those search terms in the box above "Look it up!"

G0101

"G0101 is typically paid only by Medicare."

That is not true. I have received reimbursement on G0101 from private health plans. The problem is that all the health plans have different reimbursement policies regarding the Prev Med codes, G0101, Q0091, S0610, S0612. I have posted information on Codapedia...search WWE and you will be able to read what I have posted.

Charlene Burgett, MS, CMA (AAMA), CPM, CPC, CMSCS
Administrator, North Scottsdale Family Medicine
POMAA National Advisory Board (www.pomaa.net)
Blog: www.charleneburgett.wordpress.com
Twitter: www.twitter.com/charleneburgett
Facebook: www.facebook.com/charleneburgett
LinkedIn: www.linkedin.com/in/charleneburgett

Reimbursement for G0101

We have found that UHC will reimburse the G0101 AND THE Q0091 with a modifier 25 on the 99214, but may fall to patient responsibility for a deductible or HRA account if these still apply. UHC will not pay for either G0101 or Q if coded with a preventative code regardless of any modifier and state this in their guidelines as inclusive with the preventative code. Any separate E/M at the same visit as the preventative will be paid at 50%. The 99214 with the G and Q actually reimburses more than the preventative visit because of UHC's reimbursement policy on the preventative. They encourage their beneficiaries to take advantage of the preventative benefit as it also benefits UHC costs -- the same services will not all be reimbursed. It is unfortunate and frustrating for all that the patient has to be inconvenienced with a separate visit if the physician is to receive full payment for services provided.