Practice Test Geeks(COBGC) Certified Obstetrics Gynecology Coder Practice Test
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Payer-Specific Guidelines Flashcards

7 cards from real COBGC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Payer-Specific Guidelines flashcards as text

  1. Under Medicare, which obstetric service is typically covered as a preventive benefit with no cost-sharing when billed with the appropriate preventive modifier?

    Answer: Annual well-woman exam (G0101/Q0091)

    Medicare covers the annual pelvic exam and Pap smear screening (G0101 and Q0091) as a preventive benefit, subject to frequency limits and with no beneficiary cost-sharing when billed with modifier -33.

  2. Medicaid programs in most states require prior authorization for which of the following gynecologic procedures?

    Answer: Hysterectomy for non-emergent indications

    Hysterectomy is a high-cost, major surgical procedure that most state Medicaid programs require prior authorization for when performed for non-emergent indications.

  3. When a Medicare beneficiary is also covered by an employer group health plan (EGHP) through a spouse's employer, which payer is primary for an OB/GYN procedure?

    Answer: The EGHP is primary; Medicare is secondary

    Under Medicare Secondary Payer (MSP) rules, an active employer group health plan is primary over Medicare when the group has 20 or more employees.

  4. NCCI (National Correct Coding Initiative) edits apply primarily to claims submitted to which payer?

    Answer: Medicare and Medicaid (CMS programs)

    NCCI edits were developed by CMS and apply to Medicare and Medicaid claims, though many commercial payers have adopted similar bundling logic.

  5. Medicare does NOT cover which of the following fertility-related services?

    Answer: In vitro fertilization (IVF)

    Medicare explicitly excludes coverage of infertility treatments including IVF; diagnostic procedures for other conditions that may incidentally affect fertility can still be covered.

  6. Which modifier is required when billing Medicare for a surgical procedure performed during the global period of a previous surgery by the same physician?

    Answer: Modifier -79

    Modifier -79 indicates an unrelated procedure or service performed by the same physician during the postoperative period of a prior surgery.

  7. A patient on Medicaid delivers via cesarean section. The provider wants to bill separately for the post-partum visit at 6 weeks. How do most state Medicaid programs handle this?

    Answer: It may be billed separately using the appropriate E/M code with modifier -24

    Most Medicaid programs follow a global OB package concept but allow the post-partum visit to be billed separately with modifier -24 to indicate it falls within the global period but is a distinct service.