Medicare Advamtage 99397
TL;DR how do you find out if a Medicare Advantage can get a 99397? “many but not all plans cover” Goal: MA 99214 AWV 99397 visits. Do you ever split to 99214 AWV one day and 99214 99397 another and does that help compared to both same day?
I have asked my front desk to call case by case and it can be 10-15 minute per patient. There does not seem to be a way is use a portal like for referral management to check this.
Weeds:
System policy is “you bill it patient pays it, no write offs” So: bill everyone with MA: 2wrvu and system earns 200+. But some percent of the people get a bill for 200+ bucks.
They bill 99214-25 G0439 99307-GY with GY being required per them and “patient must pay if non-covered” At least one plan said online to bill 99214 G0439-25 99397-25 which sounded both crazy and specifically different from all the other rules, so designed to get denials.
Hard for revenue cycle/billing people to track denials, or successful claims. (?? Actually hard or competing priorities) They claim one MA title may cover and same title may be a slightly different plan and not cover (eg Aetna or UHC or whatever). And that plans won’t tell them what is covered.
Posted Aug 19, 2026, 9:23 AM UTC