Forum - Questions & Answers
Determining charges for Medicare AWV with noncovered preventive visit
My provider wants to bill an AWV and a 99397 on the same day. To determine the appropriate charge for the noncovered preventive visit, do I follow the same rules that I use for an E/M on the same day as a noncovered preventive, i.e., Standard fee minus the charge for the E/M = the charge for the noncovered preventive. Or, do I charge the AWV per Medicare PFS and charge our standard fee for the noncovered preventive?
re: Determining charges for Medicare AWV with noncovered preventive visit
In my opinion, there is too much overlap between the services. I recommend billing only the AWV.
The portion of the Medicare Claims Processing Manual that described a covered and non-covered service, and subtracting the charge for the covered from the non-covered isn't there any more. The assumption is that the provider will be the covered wellness visits.
re: Determining charges for Medicare AWV with noncovered preventive visit
Thank you for your response. I spent some time researching this and couldn't find anything. I appreciate your help.