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Coding Tips for “Welcome to Medicare”


• As of 01/01/2009, an EKG is no longer required with the Initial Preventive Physical Exam


• The “Welcome to Medicare” exam is limited to one occurrence within the first 12 months of enrollment only.

• A provider performing the complete “Welcome to Medicare” physical exam and the complete EKG would report both HCPCS codes G0402 and G0366.

• If the EKG portion of the exam is not performed during the visit, another provider may perform and/or interpret the EKG. The referring provider should ensure that the performing provider bills the appropriate HCPCS G code for the screening EKG and not a CPT code in the 93000 series.

• Should an additional medically necessary EKG in the 93000 series need to be performed on the same day as the exam, report the appropriate EKG CPT code(s) with modifier 59 to indicate the additional EKG is a distinct procedural service. This EKG is
considered a separate service from the routine physical and will be subject to cost sharing per the member’s benefit policy.

• When a provider performs a separately identifiable medically necessary E/M service in addition to the “Welcome to Medicare” exam, CPT codes 99201 - 99215 reported with modifier -25 may also be billed. When medically indicated, this additional evaluation and management service would be subject to the applicable copayment for office visits.

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