Is it legal to bill for 99213 during a routine wellness exam?
It is not appropriate to bill 99213 during a routine wellness visit.
The purpose of the wellness visit, defined in the Medicare Physician Fee Schedule, is for the physician to provide preventive services. Payment is based on the value of the service to the beneficiary, not the actual work involved in providing the services.
There are specific preventive medicine (G codes) that are billed for the wellness exam.
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