Fetal Non-Stress Test (NST) 59025

A fetal non-stress test (NST) 59025 is a noninvasive test performed on pregnant women in order to monitor the fetal heart rate. A nurse will listen to and record the baby’s heartbeat while the baby is resting and while the baby is moving.  Not all pregnant women require an NST. It usually takes 20 to 40 minutes to complete an NST.

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Depression Screening

G0444 – Annual depression screening, 15 minutes

Medicare covers one depression screening per year.

Not covered if billed with G0402 “Welcome to Medicare Visit” or with  G0438 “first Annual Wellness Visit” (as per NCCI)

Covered with if billed with G0439 “subsequent Annual Wellness Visit (G0439) ” and E/M

The annual depression screening will typically include a questionnaire completed by the patient, with the help of your primary care provider in some cases If the screening finds symptoms of depression, the primary care provider will provider in some cases.


Chronic Care Management Services

CCM services are typically provided outside of face-to-face patient visits. The CCM service period is one calendar month. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.

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Colorectal Cancer Screening and Diagnostic

Colorectal Cancer (Colon cancer)

Medicare covers one screening FOBT per year for beneficiaries ages 50 or older. The test must be ordered by the patient’s treating physician. Either a stool guaiac test or a FIT will be covered, but not both. Also, at least 11 months must have passed since the month of the patient’s last test.

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Routine foot care billing

Routine foot care : 11055,  11056, 11057,  11719,  11720,  11721, G0127

Routine foot care is not a covered Medicare benefit. Medicare assumes that the beneficiary or caregiver will perform these services by themselves, and therefore, they are excluded from coverage. Medicare allows exceptions to this exclusion when medical conditions exist that place the patient at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care in the following situations:

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Insurance Plans

HMO plans

With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you need a referral before you can see any other health care professional, except in an emergency. Visits to health care professionals outside of your network typically aren’t covered by your insurance.

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NCCI Modifiers

National Correct Coding Initiative (NCCI)

The set of edits developed by CMS where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.

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Timeframe between Annual Wellness Visits (AWVs)

The exact timeframe between AWV is a little confusing.  Annual Wellness Visits (AWVs) are covered by Medicare at 12-month intervals. This means that 11 full calendar months must pass after the month in which a beneficiary had received an AWV.

For example, if AWV was performed on Jan 31, 2016 the patient is eligible to AWV starting from Jan 1, 2017

The exact day of the month doesn’t matter. AWV could have been done on Jan 1 or Jan 31 (or any other day of January) and the patient will be eligible for new AWV starting from January 1 next year.

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