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Codes for Well Woman Visit on Medicare?

Does anyone know if the code 99397 is the correct code to use for a pelvic/breast exam done by a gynecologist when on Medicare, covering the office vist/doctor's time? It appears that Medicare pays for the code G0101 which is for the actual test and is an approved benefit. Medicare reps tell me that they no longer use 99397 and the OB/GYN needs to call the provider help line for the correct code in order to be paid.

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Medicare insists it is an approved benefit, GYN says Medicare never pays on 99397 (that is correct, but should they have submitted another code?). Researching online shows that we have the option of having a physical done by an internist, opting to have the well woman cancer screening done by a GYN. The quarterly summary from Medicare shows the code used by the provider when submitting the claim. It is my first year onboard and I'm trying to figure out if the GYN is correct or the Medicare reps. I would appreciate the answer.

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Gold Post Medal for All Time! 677 Posts
September 19, 20170 found this helpful

This is a well visit code for an established patient. It should be covered

 

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