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Q&A: Billing for "Welcome to Medicare" visits


CMS has tweaked the rules on coding for its "Welcome to Medicare" program.

Q: The "Welcome to Medicare" visit has been around for a while, but we are still unsure about how to report it, the rules that surround it, how to answer patient questions about it, etc. So we pretty much have not billed for it. Can you provide a quick summary of the rules surrounding the program's use?

A: Beginning in 2005, the Medicare Modernization Act expanded benefits for beneficiaries to include the "Welcome to Medicare" visit or "Initial Preventive Physical Examination." Originally, the visit was required to be performed within six months of a patient's Medicare Part B coverage and had to contain specific elements in order to be paid. Initial requirements included a review of the patient's medical and social history with identification of risk factors, review of the patient's potential risk for depression, assessment of the patient's functional ability and level for safety, and an exam, including height, weight, blood pressure, visual acuity, and other appropriate physical assessments based on the patient's medical needs.

In addition, counseling for identifiable risk factors, education of the patient, and a checklist for obtaining appropriate screening and preventive services needed to be documented. Also, a 12-lead electrocardiogram needed to be performed and interpreted. Both services had to be billed using appropriate G codes (G0344–IPPE visit, G0365, G0366, and G0367–ECG services) in order to be paid. Patients were responsible for their 20 percent copayment-or the entire amount if their deductible had not been met.

Also, new G codes are in place to report the services: G0402 for the visit; G0403 for the ECG, including interpretation and report; G0404–ECG, tracing only; and G0405–ECG, interpretation and report only. It's a great service to new Medicare beneficiaries who may have put off having a physical examination because they lacked coverage.

The author, vice president of operations for Reed Medical Systems in Monroe, Michigan, has more than 30 years of experience as a practice management consultant and is also a certified coding specialist, certified compliance officer, and a certified medical assistant.

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