Depression Screening

G0444 – Annual depression screening, 15 minutes

Medicare covers one depression screening per year.

Not covered if billed with G0402 “Welcome to Medicare Visit” or with  G0438 “first Annual Wellness Visit” (as per NCCI)

Covered with if billed with G0439 “subsequent Annual Wellness Visit (G0439) ” and E/M

The annual depression screening will typically include a questionnaire completed by the patient, with the help of your primary care provider in some cases If the screening finds symptoms of depression, the primary care provider will provider in some cases.

 

Chronic Care Management Services

CCM services are typically provided outside of face-to-face patient visits. The CCM service period is one calendar month. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.

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Colorectal Cancer Screening and Diagnostic

Colorectal Cancer (Colon cancer)

Medicare covers one screening FOBT per year for beneficiaries ages 50 or older. The test must be ordered by the patient’s treating physician. Either a stool guaiac test or a FIT will be covered, but not both. Also, at least 11 months must have passed since the month of the patient’s last test.

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Care Plan Oversight

HCPCS Codes

G0179: MD re-certification HHA
G0180: MD certification HHA
G0181: Home health care supervision
G0182: Hospice care supervision

G0181, G0182 – Requires 30 minutes or more of physician or NPP’s time within a calendar month.

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Routine foot care billing

Routine foot care : 11055,  11056, 11057,  11719,  11720,  11721, G0127

Routine foot care is not a covered Medicare benefit. Medicare assumes that the beneficiary or caregiver will perform these services by themselves, and therefore, they are excluded from coverage. Medicare allows exceptions to this exclusion when medical conditions exist that place the patient at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care in the following situations:

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NCCI Modifiers

National Correct Coding Initiative (NCCI)

The set of edits developed by CMS where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.

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Timeframe between Annual Wellness Visits (AWVs)

The exact timeframe between AWV is a little confusing.  Annual Wellness Visits (AWVs) are covered by Medicare at 12-month intervals. This means that 11 full calendar months must pass after the month in which a beneficiary had received an AWV.

For example, if AWV was performed on Jan 31, 2016 the patient is eligible to AWV starting from Jan 1, 2017

The exact day of the month doesn’t matter. AWV could have been done on Jan 1 or Jan 31 (or any other day of January) and the patient will be eligible for new AWV starting from January 1 next year.

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Preventive Care Services

CPT 99381-99387 – Initial Comprehensive Preventative Medicine evaluation and management.
CPT 99391-99397 – Periodic Comprehensive Preventative Medicine reevaluation and management.

Includes care for preexisting conditions or minor problems. Excludes behavior change intervention (99406-99409)

(better known to offices as complete Physical Exams, Well Checks, routine physical, annual physical, annual exam, well exam, routine exam, full physical, annual routine physical)

Risk factor and behavior change modification.
CPT 99401–99405 Preventive medicine counseling and/or risk factor reduction and behavioral change intervention services provided at an encounter separate from the preventive medicine examination in areas such as family problems, diet, and exercise.

CPT 99406–99407 Smoking and tobacco use cessation counseling.

CPT 99408–99409 Alcohol and/or substance abuse structured screening.

Medicare doesn’t cover preventative services.

The CMS recognizes two HCPCS codes for billing for behavioral counseling for obesity

G0447 – face-to-face behavioral counseling for obesity, 15 minutes

G0473 – face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.