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Routine Physical ExaminationsThe Medicare program does not cover routine physical examinations or the tests directly related to a routine examination. All patients should be informed that the Medicare program does not cover preventive medicine and that they will be responsible for these charges. This information, known as the Advanced Beneficiary Notice, must be provided in writing to the patient, prior to providing the service. Frequently, in the course of a routine examination, the physician may discover a sign, symptom, or disease process that requires immediate medical attention. Both the routine examination and the covered evaluation and management code would be reimbursable when performed on the same date of service. Both service codes should be reported on the same claim. The appropriate level E&M code should be reported for the covered medically necessary portion of the service, with the appropriate preventive service code 99381-99397 reported for the non-covered portion. The usual and customary charge for the routine physical examination should be reduced by the amount charged for covered office visit service. For assigned claims, the patient would be held responsible for the charge of the routine examination, and the deductible, and coinsurance applied to the covered service. For unassigned claims, the patient is responsible for the entire charge of the noncovered service, and the limiting charge for the covered service.
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