Billing for Well Woman Preventive Visit

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Billing for Well Woman
Preventive Visit
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Billing for Well Woman Preventive Visit

• Basics of Well Woman Preventive Visit
• A well woman preventive visit is a routine
  check-up that focuses on preventive care and
  early detection of potential health problems in
  women. These visits are usually conducted by
  healthcare providers, such as gynecologists,
  family physicians, or nurse practitioners. The
  goal of the visit is to help women maintain good
  health and prevent or catch any potential health
  problems early. During a well-woman preventive
  visit, the healthcare provider typically conducts
  a comprehensive physical exam and takes a
  detailed medical history. They will also usually
  conduct some screenings and tests, such as blood
  pressure screening, Pap test, clinical breast
  exam, mammogram, cholesterol screening,
  colorectal cancer screening, and STI screening.
  The provider may also discuss other important
  topics during the visit, such as family planning,
  contraception, and menopause. Its generally
  recommended that women receive at least one
  preventive care visit per year beginning in
  adolescence and continuing across their lifespan.
• Billing Medicare for Well Woman Preventive Visit
• To bill Medicare for a Well Woman Preventive
  Visit, you must use the appropriate billing codes
  and follow Medicares guidelines for preventive
  services. Following are the steps you need to
  follow
• Use the correct billing codes Medicare uses
  three codes for well woman preventive visit
  G0101, Q0091, and 77067
• G0101 Cervical or vaginal cancer screening
  pelvic and clinical breast examinationQ0091
  Screening Papanicolaou smear obtaining,
  preparing and conveyance of cervical or vaginal
  smear to laboratory
• 77067 Screening mammography, bilateral
  (two-view study of each breast)

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Billing for Well Woman Preventive Visit
Verify eligibility Check that the patient is
eligible for Medicare and that the visit is
covered as a preventive service. Medicare covers
a well woman preventive visit once every 24
months for all female beneficiaries. However,
Medicare will cover the visit once every 12
months if the patient is at high risk for
developing breast or cervical cancer or if they
are of childbearing age and have had an abnormal
Pap test in the past 36 months. Document the
visit Document the patients medical history,
physical exam, and any other relevant information
in the medical record. Submit the claim Use the
appropriate billing codes and submit the claim to
Medicare. Make sure to include any necessary
documentation, such as the medical record and any
additional notes or reports. Follow up Check the
status of the claim and follow up with Medicare
if necessary. Remember, Medicare has specific
guidelines and requirements for preventive
services. Make sure you understand these
guidelines and follow them closely to ensure
proper reimbursement. Billing Commercial
Insurances for Well Woman Preventive Visit While
billing commercial insurances for well woman
preventive visit, its important to note that
insurance coverage and billing guidelines can
vary depending on the specific insurance plan and
the state in which you practice. Well woman
preventive visit are considered a type of
preventive service and are typically covered by
commercial insurance plans without cost-sharing
(meaning, patients are not required to pay a
co-pay or deductible for the visit). However, in
order to bill for these services, certain
requirements must be met.
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Billing for Well Woman Preventive Visit

• The patient must be asymptomatic (i.e., not
  experiencing any problems or symptoms that
  require additional evaluation or treatment).
• The visit must include a comprehensive evaluation
  of the patients health status and risk factors,
  as well as counseling and education related to
  preventive care (e.g., screening for breast
  cancer, cervical cancer, sexually transmitted
  infections, etc.).
• The visit must be performed by a qualified
  healthcare provider (e.g., a physician, nurse
  practitioner, or physician assistant) who is
  licensed and credentialed to provide preventive
  care services.
• The visit must be documented in the patients
  medical record, including a description of the
  services provided, any counseling or education
  provided, and any recommendations for follow-up
  care.
• When submitting a claim for a well woman
  preventive visit, it is important to use the
  correct procedure codes to ensure that the claim
  is processed correctly. The following are some
  common CPT codes used for well woman preventive
  visit
• CPT code 99381-99387 Used for initial
  comprehensive preventive medicine evaluations for
  patients under age 65.
• CPT code 99391-99397 Used for initial
  comprehensive preventive medicine evaluations for
  patients age 65 and over.
• HCPCS code G0101 Used for cervical or vaginal
  cancer screening.
• HCPCS code G0444 Used for annual depression
  screening.
• While many insurance plans cover well woman
  preventive visit at no cost to the patient, it is
  important to understand that there may be
  out-of-pocket costs associated with certain
  services or tests. It is important to discuss any
  potential costs with the patient before
  scheduling the visit.

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Billing for Well Woman Preventive Visit
In summary, whether you are billing Medicare or
any commercial insurance company, always pay
careful attention to proper billing guidelines.
By using the correct codes and following all
necessary procedures, providers can ensure
accurate insurance reimbursements for well woman
preventive visit. If you need billing and coding
assistance, contact us at 727-475-1834 or email
us at info_at_legionhealthcaresolutions.com
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