Preventive Medicine &

Split Billing

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Split Billing Medicare for Preventive Medicine & Sick Visit
Billing For Medically Necessary Visit On Same Occasion As Preventive Medicine Service.--When a physician furnishes a Medicare beneficiary a covered visit, at the same place and on the same occasion as a preventive medicine service (CPT codes 99381-99397), consider the covered visit to be provided in lieu of a part of the preventive medicine service of equal value to the visit. A preventive medicine service (CPT codes 99381-99397) is a non-covered service. The physician may charge the beneficiary, as a charge for the noncovered remainder of the service, the amount by which the physician's current established charge for the preventive medicine service exceeds his/her current established charge for the covered visit. Pay for the covered visit on the basis of the lesser of the fee schedule amount or the physician's actual charge for the visit. The physician is not required to give the beneficiary written advance notice of noncoverage of the part of the visit that constitutes a routine preventive visit. However, the physician is responsible for notifying the patient in advance of his/her liability for the charges for services that are not medically necessary to treat the illness or injury.
There could be covered and non-covered procedures performed during this encounter (e.g., screening x-ray, EKG, lab tests.). These are considered individually. Those procedures which are for screening for asymptomatic conditions are considered noncovered and, therefore, no payment is made. Those procedures ordered to diagnose or monitor a symptom, medical condition, or treatment are evaluated for medical necessity and, if covered, are paid.
Medicare Carrier Manual Section 15501 E Preventive Medicine & Sick Visit
BCBS Iowa: If a condition or symptom is discovered in the process of performing a physical & if the dx and treatment of condition or symptom requires a significant effort in the form of additional work up that requires the performance of the key components of a problem-oriented services, then you may bill an E/M code (99201-99215) in addition to the routine physical without modifier 25 on office visit. BCBS views significant effort as all of the following
1. Additional time required to diagnose and treat additional problem(s)
2. Physician faces increased risk factors in managing the patient's care. Physician gathers & analyzes info. To treat the additional problem or determine possible management option
3. Physician develops Assessment & Plan
4. Condition requires a continued regimen of care that is medically necessary to monitor the patient's progress
Split Billing Blue Cross Blue Shield of Iowa
BCBS of Nebraska: BCBS of Nebraska does recognize 25 modifier. Medical records must document that the other condition is warranted and an assessment was done.
Mutual of Omaha (Exclusicare)
Billing for a preventive health visit and a sick visit would require documentation to support both visits per E/M documentation guidelines (all key components must be met for both in order to bill two separate services)

The preventive health visit would be billed using CPTcode 99381-99387 or 99391-99397. The ill visit would be billed with a modifier -25 appended to one of the E/M codes (99201 - 99215). For Mutual of Omaha products, if the

visit is a level 1, 2, or 3 - - -office notes are not needed, however if a level 4 or level 5 E/M is billed, office notes must accompany the claim.
Please let me know if you need additional information

Medicaid Nebraska response

Medicaid does not require you to subtact the charge of the office visit from the preventative medicine visit, you may bill both "as is". Medicaid does require attached documentation to show substantial time was spent on a
problem in addition to the preventative medicine visit. Discovering otitis media during a preventative medicine visit, writing a script and requesting the patient return for follow up in a week or two would not be covered as two (preventative medicine and E&M) visits by Medicaid.
Lorelee Novak, Nebraska Medicaid

United:

If Preventive Medicine Services dominates over 50% of the visit the first diagnosis is appropriate V code along with Preventive Medicine CPT code. If 50% of the visit is disease related use appropriate E&M 99201-99215 along with sick dx. Do not use preventive medicine codes. If both are billed we will reimburse the lesser of the two

 
     
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