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Posted By Gracie Ermitano on 06-03-2019, 18:09:09 in Ob-Gyn
This is the first time I encountered that an insurance carrier allows billing for an initial preventive service (9938x) for an annual health maintenance visit and a well woman exam using the periodic comprehensive exam (9939x) few days or within a week after. This is unusual to me with a PCP billing for the same set of codes for preventive and well woman visit. I understand rules may vary and I made my research and try to find the answer to this kind of set-up. In the provider's billing manual, that specific carrier allows for billing preventive codes (9938x/9939x) but I haven't encountered any guidelines pertaining to well woman visits or using G0101 and Q0091 just like Medicare. Any feedback that you can provide especially those in other states? Thank you very much.
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Posted By Melanie Witt on 06-04-2019, 14:42:26
The G0101 and Q codes only apply to Medicare so they have developed their own criteria for billing. If the payer who is allowing the periodic codes for a well-woman exam do not have a policy on the requirements for the visit, I would follow the ACOG guidelines by age group. You can access this via their website locations as follows:
https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Well-Woman-Visit?IsMobileSet=false

News-Releases/2018/ACOG-and-WPSI-Release-Materials-to-Support-Womens-Preventive-Care-at-Every-Life-Stage?IsMobileSet=false
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