Annual Physicals male & female for Medicare patients

How do I bill for a patient visit in which an Annual Physical exam is done for a Medicare patient? I realize preventive physical codes 99381-99397 are not covered by Medicare; but I've also been told that Medicare's new AWE codes G0402, G0438 & G0439 are not actual physical exams wherein the provider examines the patient from head to toe and everywhere in between as it were. That they are more or less verbally going over medical issues and patient histories and setting up needed tests. What then is the correct method of billing an Annual Physical Exam with or without breast/pelvic or prostrate/rectal exams? I'm thoroughly confused and to make matters worse both our providers and patientsseem to think annual physicals are the AWE's and expect them to be billed as such and therefore no copay or deductible being left for the patient; and we get outraged calls if they do.

re: Annual Physicals male & female for Medicare patients

Basically the important thing to understand is that an annual wellness visit and a physical are totally different things to Medicare. I have a beautiful PDF from Medicare explaining each type of visit, what CPT/HPCS codes to use for each and what is and isn't supposed to be billed to Medicare. Of course the link where I got it is no longer active. If there's any way I could email it to you or upload it somewhere for you I'm happy to do so, just reply back with your preferred method to get it to you. It is still current.

re: Annual Physicals male & female for Medicare patients

But to summarize:

Initial Preventive Physical Exam = both medical/social history, screenings for depression and functional ability (e.g. falls in the home, ease of movement in the home) and an actual physical. Also end of life planning, if the patient is interested. It's called an "INITIAL Physical Exam" because this exam is only available once, and must be done within 12 months of the patient becoming eligible for Medicare Part B. If it occurs outside of this limited time period, it will be denied (which may be adding to confusion).

HCPCS Code = G0402


Annual Wellness Visit = The subsequent annual visits that can begin 12 months after the Initial Preventive Physical Exam. Physical exam will be tailored the the patient's individual history, but generally should include height, weight, BMI, and other standard vitals at the very least. A list of current providers and medications should be taken, all the screenings from the IPPE should be re-visited as should screenings for cognitive impairment. A plan should be created for the next 5-10 years to establish a screening schedule based on age-appropriate services and patient need.

HCPCS Code = G0438 (first visit) G0439 (every subsequent visit)

re: Annual Physicals male & female for Medicare patients

I recommend that in addition to the wellness visit requirements, the clinician also do a physical. The regulations require height/weight/calculation of BMI, BP, visual acuity for the welcome to Medicare visit and "other physical exam as deemed appropriate" by the clinician. You are not prohibited from a physical it is just not separately reimbursed. (Except for the G0101 when covered.)

re: Annual Physicals male & female for Medicare patients

I would like this information also please email at cindyOPT@bayland.net.
Thank you in advance

re: Annual Physicals male & female for Medicare patients

Sent! Let me know if you didn't receive it.