Forum - Questions & Answers

Sep 16th, 2016 - cdampier

Billing question

Can an annual wellness be billed on the same day as TCM? Does it need a modifier, if so?

Thank you!

Claudia Dampier

Sep 20th, 2016 - zuni.transcure 1 

re: Billing question

Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter. It is important that the elements of the AWV not be replicated in the medically necessary service. Physicians must append modifier -25 (significant, separately identifiable service) to the medically necessary E/M service, e.g. 99213-25, to be paid for both services.

Zunoorain Mohsin

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