Reader Question: Skip 99397 for Medicare

Article Overview

This reader question and answer addresses a Medicare denial involving a preventive medicine service for an older patient and explains the general coverage distinction between preventive care and established patient office visits. It is useful for physicians, coders, and billing staff who need to understand payer policy differences, especially when Medicare or Medicare replacement plans are involved. The article also notes that payer-specific policies can affect whether the service is covered, making it relevant for practices that routinely verify benefits before submitting claims.