This is an once-in-a-lifetime benefit and it must be performed within six months after the effective date of the beneficiary’s first Part B coverage, but only if such Part B coverage begins on or after January 1, 2005. Neither the Co-payment (20% of the Approved Amount) nor the deductible ($110 for 2005) is waived. This is payable by the patient.
How to Bill the Service:
Par Fee Schedule
*Both components, the examination and the EKG, must be performed for either of the components to be paid.
A separate medically necessary E/M service (CPT codes 99201 through 99215) may be billed on the same day as the “Welcome to Medicare” visit. Use a modifier –25 on the CPT E/M code. CMS states that this shouldn’t be a typical occurrence and the agency will monitor utilization patterns for level 4 and 5 E/M services. The visit must be medically necessary to treat the patient’s illness or injury or to improve the function of a malformed body member.