It happens from time to time: Your provider performs an annual wellness visit (AWV) and also handles transitional care management (TCM) at the same visit. In these instances, can you submit a claim to Medicare with both G0439 and 99495 on it?
In most cases, the answer is yes, but not always. Read on to discover what you need to know about reporting G0439 and 99495 together.
Get to Know the Codes
The first step in determining whether you can report an AWV along with TCM is to ensure you’re looking at the right coding options. Following are the most commonly reported codes for these services.
- 99495 — Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge At least moderate level of medical decision making during the service period Face-to-face visit, within 14 calendar days of discharge
- G0439 — Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit
If you perform a true TCM service, look to 99495, while you’ll opt for G0439 for an AWV.
Discover What NCCI Says
The National Correct Coding Initiative (NCCI) is a tool that Medicare carriers use to determine which codes can and cannot be reported together. If the NCCI includes an edit bundling two codes together, you typically cannot report them on the same claim.
In the case of G0439 and 99495, the NCCI does not include an edit bundling these two codes, which means Medicare payers should allow you to bill them together.
Check What Payers Say
You should always consult your Medicare contractor for specific information on what they will and won’t allow you to bill together. For instance, Part B payer NGS Medicare says on its website, “The TCM appointment may take place on the same date as the AWV. It is important to note that all expected elements of both services must be documented in the medical record individually.”
Note the importance of the final line of NGS Medicare’s statement. You must document and meet all elements of both services before you can report them, and document each individually.
What this means: You must be able to separate your AWV documentation from your TCM documentation to be able to report each. You can’t have overlapping documentation to try and “double dip” and collect for both services. Always keep the notes separate and distinct from one another so you can compliantly report both G0439 and 99495 to your payers.
| Don’t get tripped up by the E/M coding rules — let an expert help you iron out which services you can and cannot report together. Coding specialist Toni Elhoms, CCS, CPC, CPMA will walk you through the must-know facts during her latest online training, Master New 2025 Telehealth CPT Codes to Get Paid. Register today! |
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