Not payable with modifier -25 + minor procedure same dayAllowed with modifier -25 + AWV/vaccine/Part B preventive (effective 1/1/2025)Medicare only — most commercial payers not yet coveringNot payable at RHC or FQHC
Medicare covers — commercial coverage inconsistent, verify per payerCannot bill if same-problem E&M billed within 7 daysCannot bill if results in in-person visit within 24 hoursAnnual patient verbal consent required
Medicare covers — commercial coverage inconsistent, verify per payerCannot bill if same-problem E&M billed within 7 daysAnnual patient verbal consent required
Medicare covers — commercial coverage inconsistent, verify per payerCannot bill if same-problem E&M billed within 7 daysAnnual patient verbal consent required
F2F within 14 days of dischargeCannot bill with 99214 on same DOS
F2F within 7 days of dischargeCannot bill with 99215 on same DOS
Once per Medicare lifetime (initial)
Once per year
One-time lifetime benefitWithin first 12 months of Part B enrollment
Not covered by Medicare — use G0438/G0439 for Medicare patients
Not covered by Medicare
Once per year
AnnualMust document SDM and written LDCT order
Once per year
Up to 4 sessions per year
Once per yearNo patient cost-sharing
Up to 2 sessions per year
Once per year
Weekly x 3 months, then monthly — up to 22 sessions/year
Up to 8 sessions per year (2 attempts of 4 sessions each) — MedicareNo modifier needed when billed same day as E&M
wRVU = 0.00 (practice expense only)
Requires ≥16 min face-to-faceNo Medicare cost-sharing
Irrigation alone does not qualify — must use curette/suction/forceps
17003 for lesions 2–14 (report quantity)17004 for 15+ (flat fee)
Once per monthPatient consent required2+ chronic conditions required