Forum - Questions & Answers

Jul 14th, 2011 - Correna 1 

Welcome to Medicare billing EKG

When a new pt establish care and is having and ekg done for their welcome to medicare physical, do I split the ekg coding and bill a portion to Medicare A and then the other half to Medicare B. And if so do we use the "G" codes to do so

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Jul 14th, 2011 -

re: Welcome to Medicare billing EKG

Both services get billed to MCR Part B if performed in the physician's office. CMS Preventative Services Quick Reference Information has an easy read chart at: http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
Bill G0402 for the Exam, and either G0403, G0404 or G0405 for the EKG depending on which portion of the service your doc performed.

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Jul 14th, 2011 - Correna 1 

re: Welcome to Medicare billing EKG

As shannan posted, I am billing for an fqhc, and the componets are billed differently. So again how is this billed for welcome to Medicare

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Jul 20th, 2011 -

re: Welcome to Medicare billing EKG

I have to edit my previous comment. Right after I posted this, I sat in on a CMS National Provider Call. We were instructed (as an FQHC) to code/bill an EKG as part of the IPPE visit with codes --

G0403 as a screening for the IPPE with interpretation and report;
G0404 as a screening for the IPPE, tracing only without interpretation and report;
G0405 as a screening for the IPPE, interpretation and report only

The IPPE (G0402) is a one-time benefit that must be provided within 12 months of the effective date of a beneficiary's Medicare Part B coverate. The screening EKG (G0403, G0404, G0405), when done as a referral from an IPPE, is also only covered once during a beneficiary's lifetime. Effective dates of serive on or after January 1, 2011, the coinsurance or copayment or deductible ware waived for the IPPE -- ONLY. However, the deductible and coinsurance still applies to the screening EKG.

Hope this helps!

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Jul 14th, 2011 - Shannan 28 

re: Welcome to Medicare billing EKG

Does it make a difference if you are doing billing for and FQHC?

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Jul 20th, 2011 - gvardalos 1 

re: Welcome to Medicare billing EKG

I work in a large primary care clinic and we have had problems getting Medicare to pay for EKG as part of the Welcome to Medicare CPE. We are only getting paid if the DX is within the LCD/NCD guidelines (always a sick code). Is anyone getting Medicare to pay EKGs for preventative or screening reasons? If so, what code are you billing. This info would be greatly appreciated

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Jul 26th, 2011 -

re: Welcome to Medicare billing EKG

In the CMS National Provider call we were instructed:

"Although a dx code must be reported on the claim, there are no specific IDC-9 dx codes that are required for the IPPE; therefore, Medicare providers should choose an appropriate dx code."

There were a lot of questions on the call about the dx codes and many people were skeptical.

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Jul 27th, 2011 -

re: Welcome to Medicare billing EKG

We bill G0403 linked to v70.0 for the EKG and get paid every time!

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Sep 7th, 2011 - billings123 74 

re: Welcome to Medicare billing EKG

Exactly what are the codes when billing for "welcome to medicare"? V70.0, G0344, G0403? Is G0101 AND Q0091 be paid also under "welcome to medicare"?

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Sep 7th, 2011 - rphelps 615  1 

re: Welcome to Medicare billing EKG

I recently used G0402 with 250.00 and got paid 121.26 and G0405 with 401.1 and got paid 5.81. NO G0101 and Q0091 are not a part of the IPPE.

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