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NGS will automatically reprocess AWV claims

The Medicare Administrative Contractor (MAC) National Government Services (NGS, New York, Connecticut) sent out the following message regarding the new annual wellness visit service this afternoon. 

The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 7079 on December 3, 2010, which directed the implementation of Medicare’s annual wellness visit (AWV) under Section 4103 of the Affordable Care Act. Coverage and payment of the AWV were effective January 1, 2011. 

Some providers billing for the AWV have included the “routine service” diagnosis code on their claims. Moreover, because Medicare does not pay for routine services, some contractors apply auto-deny edits whenever this “routine service” diagnosis is included on the claim. Consequently, some contractors are denying AWV claims when they should be paid.
CMS has directed contractors to not auto-deny claims for Healthcare Common Procedure Coding System (HCPCS) codes G0438 and G0439 when billed for an AWV in accordance with CR 7079. Based on this direction, National Government Services omitted the editing for diagnosis code V70.0 that is allowable with HCPCS codes G0438 and G0439, and claims that were initially denied are being reprocessed.

If your Medicare carrier isn't NGS, you can probably expect your MAC to take similar steps. CMS is advising you to work out any further billing issues with your carrier.

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