Do you Bill G codes to Medicare Advantage plans?

Q – If a patient has a managed Medicare plan (non-traditional Medicare), can I still bill a G code (G0402, G0438, or G0439) for a wellness visit? A – Yes. Traditional Medicare and all managed Medicare plans will accept the G codes for AWVs.

Do Medicare Advantage plans use the Medicare fee schedule?

Unlike Original Medicare, there is no definite rule about how APRNs are paid in MA. Plans may use the Fee Schedule as a reference, but they are not required to do so. There is very little transparency in MA payments to providers, so APRNs have to be their own negotiators.

What are status B indicator codes?

Status indicator B codes describe a code which is included in the reimbursement for another service, whether billed on the same date of service as the primary code or billed alone and on a different date of service.

Do G codes need modifiers?

For each non-payable G-code reported, a modifier must be used to report the severity level for that functional limitation. The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the providers or practitioners furnishing the therapy services.

What does Status Indicator G mean?

G Pass-Through Drugs and Biologicals Paid under OPPS; Separate APC payment includes pass-through amount. H Pass-Through Device Categories Separate cost-based pass-through payment; Not subject to coinsurance.

What are B bundle codes?

B = Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amounts for these codes and no separate payment is ever made.

When should G codes be used?

G-codes are used to report a beneficiary’s functional limitation being treated and note whether the report is on the beneficiary’s current status, projected goal status, or discharge status.