Billing for Well Woman Preventive Visit

Billing for Well Woman Preventive Visit

Basics of Well Woman Preventive Visit

A well woman preventive visit is a routine check-up that focuses on preventive care and early detection of potential health problems in women. These visits are usually conducted by healthcare providers, such as gynecologists, family physicians, or nurse practitioners. The goal of the visit is to help women maintain good health and prevent or catch any potential health problems early. During a well-woman preventive visit, the healthcare provider typically conducts a comprehensive physical exam and takes a detailed medical history. They will also usually conduct some screenings and tests, such as blood pressure screening, Pap test, clinical breast exam, mammogram, cholesterol screening, colorectal cancer screening, and STI screening. The provider may also discuss other important topics during the visit, such as family planning, contraception, and menopause. It’s generally recommended that women receive at least one preventive care visit per year beginning in adolescence and continuing across their lifespan.

Billing Medicare for Well Woman Preventive Visit

To bill Medicare for a Well Woman Preventive Visit, you must use the appropriate billing codes and follow Medicare’s guidelines for preventive services. Following are the steps you need to follow:

  • Use the correct billing codes: Medicare uses three codes for well woman preventive visit – G0101, Q0091, and 77067
    • G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examinationQ0091: Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
    • 77067 – Screening mammography, bilateral (two-view study of each breast)
  • Verify eligibility: Check that the patient is eligible for Medicare and that the visit is covered as a preventive service. Medicare covers a well woman preventive visit once every 24 months for all female beneficiaries. However, Medicare will cover the visit once every 12 months if the patient is at high risk for developing breast or cervical cancer or if they are of childbearing age and have had an abnormal Pap test in the past 36 months.
  • Document the visit: Document the patient’s medical history, physical exam, and any other relevant information in the medical record.
  • Submit the claim: Use the appropriate billing codes and submit the claim to Medicare. Make sure to include any necessary documentation, such as the medical record and any additional notes or reports.
  • Follow up: Check the status of the claim and follow up with Medicare if necessary.

Remember, Medicare has specific guidelines and requirements for preventive services. Make sure you understand these guidelines and follow them closely to ensure proper reimbursement.

Billing Commercial Insurances for Well Woman Preventive Visit

While billing commercial insurances for well woman preventive visit, it’s important to note that insurance coverage and billing guidelines can vary depending on the specific insurance plan and the state in which you practice. Well woman preventive visit are considered a type of preventive service and are typically covered by commercial insurance plans without cost-sharing (meaning, patients are not required to pay a co-pay or deductible for the visit). However, in order to bill for these services, certain requirements must be met.

  • The patient must be asymptomatic (i.e., not experiencing any problems or symptoms that require additional evaluation or treatment).
  • The visit must include a comprehensive evaluation of the patient’s health status and risk factors, as well as counseling and education related to preventive care (e.g., screening for breast cancer, cervical cancer, sexually transmitted infections, etc.).
  • The visit must be performed by a qualified healthcare provider (e.g., a physician, nurse practitioner, or physician assistant) who is licensed and credentialed to provide preventive care services.
  • The visit must be documented in the patient’s medical record, including a description of the services provided, any counseling or education provided, and any recommendations for follow-up care.

When submitting a claim for a well woman preventive visit, it is important to use the correct procedure codes to ensure that the claim is processed correctly. The following are some common CPT codes used for well woman preventive visit:

  • CPT code 99381-99387: Used for initial comprehensive preventive medicine evaluations for patients under age 65.
  • CPT code 99391-99397: Used for initial comprehensive preventive medicine evaluations for patients age 65 and over.
  • HCPCS code G0101: Used for cervical or vaginal cancer screening.
  • HCPCS code G0444: Used for annual depression screening.

While many insurance plans cover well woman preventive visit at no cost to the patient, it is important to understand that there may be out-of-pocket costs associated with certain services or tests. It is important to discuss any potential costs with the patient before scheduling the visit.

In summary, whether you are billing Medicare or any commercial insurance company, always pay careful attention to proper billing guidelines. By using the correct codes and following all necessary procedures, providers can ensure accurate insurance reimbursements for well woman preventive visit. If you need billing and coding assistance, contact us at 727-475-1834 or email us at