welcome to medicare exam

Coding Tips For “Welcome To Medicare”

The ‘Welcome to Medicare’ exam can occur only once within the first year of enrollement. A health provider that needs to complete the EKG and has to do the “Welcome to Medicare” physical exam should report HCPCS code G0366 and HCPCS code G0402.

Another health provider can perform or/and interpret the EKG if the EKG portion of the ‘Welcome to Medicare’ exam is not performed by the during the day of the exam. Make sure that the performing provider bills the correct HCPCS for the EKG screening and not any of the CPT codes of the CPT 93000 series.

Report the correct EKG CPT codes in combination with modifier 59 to show that the additional EKG is a distinct procedural service if an additional medically necessary EKG of the CPT code 93000 series is performed on the day of the exam.

You can consider a separate service from the routine physical. This is subject to the cost sharing of a member’s benefit policy.

Use CPT 99201 until CPT 99215 with modifier 25 if an health provider performed a separately identifiable medically necessary Evaluation and Management service in addition to the ‘Welcome to Medicare’ exam,

This E/M service is subject to applicable copayment for office visits if it is medically indicated.

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