Medicare Annual Exam Cuts Benefit, Requires Detailed Coding in RHCs

January 5, 2011

One element that physicians cheered in the new Medicare annual wellness exam has been eliminated and another that beneficiaries demanded will be delayed.

Bowing to Republican pressure, the White House agreed to cut the voluntary after care planning that was listed as an option in G0438 and G0439. In addition, Rural Health Clinics will need to wait 30 days after providing these new services to have the claims properly processed and will have to jump though hoops to ensure beneficiaries are not charged a deductible or copayment.

Although the new benefit does not apply a deductible or cocharge for G0438 or G0439, RHC claims forms and processing systems will not be set up to directly accept the new codes until April 4. Detailed reporting is required as outlined in Transmittal 2122.

For more on the G code inclusions, listen to AudioEducator’s 2011 Primary Care Coding Update

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