IMMUNIZATIONS

 Zostavax and Hepatitis are considered covered, but not separately payable. 

 These are to be bundled with the RHC encounter and billed on the UB 04 format. 

 The patient cannot be charged and they cannot be logged in the Flu/Pneumo logs

PROCEDURES

 Procedures performed on the same day as an RHC encounter will be bundled and ONE RATE will be paid for the entire encounter.

FLU/PNEUMOVAX

 These injections are covered under the RHC program. 

 Regular Medicare services are NOT to be billed on a claim. 

 A log needs to be kept for these injections and they are submitted on the cost report. They will be paid at annual cost report reconciliation. 

 Date of service 

 Patient name 

 Patient Medicare Number 

 Medicare HMOs are to be billed on a HCFA 1500 with the administration code. Use Medicare billing CPT codes for Flu/pneumo. (G code series)

WELCOME TO MEDICARE

 This is payable once per lifetime 

 The service must be rendered within twelve months of the patient becoming eligible for Medicare or if they are enrolled in Medicare and they have NOT had their welcome visit. 

 The co-insurance/deductible are not applicable to this service 

 Only one payment is made for this RHC encounter. 

 For an Independent RHC all diagnostic screenings are billed to Medicare Part B. 

 For a Provider Based RHC all diagnostic screenings are billed under the Main provider Medicare A on UB 04 

 Codes G0402, G0438, G0439 must be billed on their own claim line and must have the CPT code on the UB04 claim form. If other services are performed on the same day and they meet the requirement of separately identifiable face-to-face encounter, they will be bundled together on their own line item separate from the G codes listed and they will not need CPT codes on the UB 04 form but will be in the revenue line item. 

 G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment 

 G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 

 G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit