Billing the Welcome to Medicare visit

This is an once-in-a-lifetime benefit and it must be performed within six months after the effective date of the beneficiary’s first Part B coverage, but only if such Part B coverage begins on or after January 1, 2005.  Neither the Co-payment (20% of the Approved Amount) nor the deductible ($110 for 2005) is waived.  This is payable by the patient.

How to Bill the Service:

*Both components, the examination and the EKG, must be performed for either of the components to be paid.

A separate medically necessary E/M service (CPT codes 99201 through 99215) may be billed on the same day as the “Welcome to Medicare” visit.  Use a modifier –25 on the CPT E/M code.  CMS states that this shouldn’t be a typical occurrence and the agency will monitor utilization patterns for level 4 and 5 E/M services.  The visit must be medically necessary to treat the patient’s illness or injury or to improve the function of a malformed body member.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.