By Jon Brubaker, MD Buyline Clinical Analyst
CMS has issued a Reminder with the most recent MLN Matters Newsletter that Medicare provides coverage for eligible beneficiaries for a one-time ultrasound screening for abdominal aortic aneurysm (AAA) when referred as a part of the initial preventative physical examination (IPPE). CMS is seeking help to get this word out to new beneficiaries.
In January 2005, Medicare expanded the number of preventive services available to Medicare beneficiaries as a result of Section 611 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003, to include coverage under Medicare Part B of a one-time IPPE. IPPE also is referred to as "Welcome to Medicare" physical exam. This is available to all Medicare beneficiaries whose Medicare Part B effective date began on or after January 1, 2005.
In Jan. 2007, the Medicare program further expanded the number of preventive benefits, as provided for in Section 5112 of the Deficit Reduction Act (DRA) of 2005 to include the one-time ultrasound screening for early detection of AAA for at risk beneficiaries.
These benefits for IPPE and AAA are subject to some eligibility limitations. The one-time IPPE visit must be received by the beneficiary within the first six months of their Medicare Part B effective date. The IPPE is a preventive evaluation and management service that includes seven components:
A review of an individual's medical and social history with attention to modifiable risk factors.
A review of an individual's potential (risk factors) for depression.
A review of an individual's functional ability and level of safety.
An examination to include an individual's height, weight, blood pressure, and visual acuity screen.
Performance of an EKG with interpretation.
Education, counseling and referral based on the results of the review and evaluation.
Education, counseling and referral including written plan as a checklist provided to the individual for obtaining the appropriate screenings and other preventive services that are covered as separate Medicare Part B benefits.
Effective for dates of service after Jan. 2007, Medicare will pay for a one-time preventive ultrasound screening for AAA for beneficiaries who are at risk (family history of AAA or is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime). Eligible beneficiaries must receive a referral for the screening as a part of their Welcome to Medicare physical exam. There is no Part B deductible applied to this benefit but coinsurance/copayment applies. If the screening is provided in a physician office, the service is billed to the carrier using HCPCS code G0389, B-scan and/or real time with image documentation for AAA screening, short descriptor "Ultrasound exam AAA," Modifiers TC, 26 (optional).
For more information about Medicare's coverage criteria and billing procedures for the AAA and IPPE benefits, refer to the following MLN Matters article: MM5235 (2006), "Implementation of a One-Time Only Ultrasound Screening for Abdominal Aortic Aneurysms (AAA), Resulting from a Referral from an Initial Preventive Physical Examination,"