Wiki CPT 99483 AND G0439

[sharic2]

WHICH MODIFIER WOULD BE NEEDED TO GET BOTH CODES PAID BY MEDICARE? MEDICARE CLEARLY STATES THAT MODIFIER 25 IS NEEDED BUT DOES NOT PAY WHEN ADDED TO CPT 99483 AND DOES NOT ACCEPT A MODIFIER ON G0439. I HAVE ALSO TRIED MODIFIER XU. MODIFIER 59 IS DISCOURAGED BY MEDICARE WITH THIS CPT CODE. LOOKING FORWARD TO YOUR ANSWERS. THANK YOU.

 

[midnight1995]

Per the NCCI guidelines Code G0439 is a column 2 code for 99483, but you may use a NCCI-associated modifier to override the edit under appropriate circumstances. Modifier 25.
You can also refer to your MAC Carrier for Medicare (not sure what state) Billing and Coding: Cognitive Assessment and Care Plan Services https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59036&ver=11&
In the link above it does stated CPT code 99483 is generally billed separately from the annual wellness visit due to the time, complexity and medical decision making inherent to this service. However, if the AWV and Cognitive Assessment and Care plan services are done at the same visit, a -25 modifier would need to be appropriately utilized.
Hope this helps.