From the Guidelines
Medicare does pay for a 99214 Evaluation and Management (E/M) code when billed with the G-code for an Annual Wellness Visit (AWV) on the same day, provided specific requirements are met. The E/M service must be medically necessary and separate from the AWV, addressing a significant problem that requires additional work beyond the AWV's preventive focus. When billing both services together, you must append modifier -25 to the E/M code (99214-25) to indicate it was a significant, separately identifiable service. Although the provided study 1 primarily discusses telepsychiatry and does not directly address the billing of E/M codes with AWV G-codes, it mentions the use of Healthcare Common Procedure Coding System or Common Procedural Terminology (CPT) codes and the importance of proper billing and reimbursement for services. However, based on general knowledge of Medicare billing guidelines, it is essential to ensure that the E/M service is properly documented and coded to distinguish it from the AWV components. Medicare will reimburse both services at 100% of the allowed amount when properly documented and coded. This combined billing approach allows providers to address both preventive care needs and acute or chronic conditions efficiently during a single patient visit, maximizing both clinical care and appropriate reimbursement. Key points to consider include:
- The medical necessity of the E/M service
- The use of modifier -25 to indicate a separately identifiable service
- Clear documentation distinguishing between AWV and E/M components
- Proper coding and billing to ensure reimbursement for both services.
From the Research
Medicare Payment for 99214 Code with G-Code for AWV
- Medicare's payment policies for Annual Wellness Visits (AWVs) and Evaluation and Management (E/M) services are complex and have evolved over time.
- The provided studies do not directly address the question of whether Medicare pays for a 99214 code when billed with the G-code for an AWV on the same day 2, 3, 4, 5, 6.
- However, it is known that Medicare covers AWVs as a preventive service, and the G-code is used to bill for this service.
- The 99214 code is an E/M code used to bill for office visits, and its payment is subject to Medicare's E/M payment policies.
- There is no clear evidence in the provided studies to suggest that Medicare pays for a 99214 code when billed with the G-code for an AWV on the same day, as the studies focus on the utilization and effectiveness of AWVs, rather than the specific billing and payment policies 2, 3, 4, 5, 6.
Billing and Payment Policies
- Medicare's billing and payment policies for AWVs and E/M services are outlined in various regulations and guidelines, but these are not addressed in the provided studies.
- It is possible that Medicare may have specific rules or guidelines governing the billing and payment of 99214 codes when submitted with G-codes for AWVs, but these are not mentioned in the studies 2, 3, 4, 5, 6.
- Further research or consultation with Medicare's payment policies and guidelines would be necessary to determine the answer to this question.