Sometimes, a patient presents only for a breast exam, perhaps prior to a mammogram. Is that a separately billable service?
Newly found lump: A patient who presents with a newly discovered lump and presents to the office can be billed with new or established patient visit codes (depending on the patient status, 99201--99215). Select a code based on the level of service. (History, exam, MDM or time, as appropriate.)
Part of a preventive medicine visit: The breast exam is part of an age/gender appropriate exam.
As part of a pelvic and clinical breast exam on a Medicare patient: Bill code G0101 for Medicare patients (frequency and diagnosis limists apply, see article in Codapedia on this topic.) G0101 must include the clinical breast exam and a total of 7 of the 11 exam elements.
Breast exam only: There is no code for performing only a breast exam.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:
Quality of ...
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...