Seasonal wrote: ↑Wed Aug 04, 2021 1:20 pm
Here's what Medicare says:
You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.
However, you may have to pay coinsurance, and the Part B deductible may apply if:
- Your doctor or other health care provider performs additional tests or services during the same visit.
- The preventative benefits don't cover these additional tests or services.
https://www.medicare.gov/coverage/welco ... tive-visit
A Welcome to Medicare is not the same at all like physical exams you have had in the past. It does not include urine and blood lab tests. It does not include an EKG. If your doctor performs those during this visit, Medicare will not pay for them and you will be responsible for the bill. Your doctor can write a referral to have blood and urine tests done. They will need to be done another day.
On your link, it will tell you the 10 things this visit will cover. Among them listed is a vision test, taking your BMI, and a discussion about advanced directives and end-of-life documents.
This is just how the government set up this "Welcome to Medicare visit" to work and why they warn people that they may have to pay coinsurance and the Part B deductible may apply. Bottom line, Medicare does not pay well, so doctors will be more apt to do more to get more money.
The doctor will code your visit accordingly. It is all about the coding. A new patient visit usually will be coded as 99203 (low complexity) or 99204 moderate complexity). A follow visit or established patient will be coded as 99213 (FUO, low complexity) or 99214 (FUO, moderate complexity). A new patient codes requires the following three key components: history, exam, medical decision making. An established patient requires only two of those three. Those codes also determine what Medicare will pay, what the doctor can charge. For 99203, you may end paying around $35. For code 99213, around $16.
So if you discuss other than or the doctor does more than the 10 items listed, and the doctor does includes all three components, the bottom line, you may and most likely will be responsible for a coinsurance.