Preventive Services List: I-Z - JE Part A
Preventive Services List: I-Z
Medicare covers the following preventive services and screenings, subject to certain eligibility and other limitations.
Influenza Virus Vaccine and Administration
HCPCS/CPT Codes |
|
---|---|
Frequency | Once per influenza season (additional flu shots are covered if medically necessary) |
Diagnosis Code | Z23 - Encounter for immunization |
Coverage | All Medicare beneficiaries |
Payment | Copayment/coinsurance waived; Deductible waived |
Resources |
|
Roster Billing |
|
Noridian Medicare Portal | No |
Initial Preventive Physical Examination (IPPE)
HCPCS/CPT Codes |
|
---|---|
Frequency | Once in a lifetime and must be furnished no later than 12 months after effective date of first Medicare Part B coverage period |
Coverage |
|
Payment |
|
Resources | |
Noridian Medicare Portal | Yes - G0402, G0403, G0404, G0405 |
Intensive Behavioral Therapy (IBT) for Cardiovascular Disease
HCPCS/CPT Codes |
G0446 - Annual, face-to-face intensive behavioral therapy for cardiovascular disease |
---|---|
Frequency | Annually |
Coverage |
|
Therapy Components |
|
Counseling Requirements |
Counseling is to be completed based on Five As Approach
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0446 |
Intensive Behavioral Therapy (IBT) for Obesity
HCPCS/CPT Codes |
|
---|---|
Frequency |
Notes:
|
Diagnosis Code |
|
Coverage |
|
Counseling Requirements |
Counseling is to be completed based on Five As Approach
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0447 and G0473 |
Lung Cancer Screening
HCPCS/CPT Codes |
|
---|---|
Frequency | Annually First year: Before first screening, beneficiary must receive counseling and shared decision making visit Subsequent years: Beneficiary must receive written order furnished during appropriate visit with physician or non-physician practitioner |
Diagnosis Code |
Z87.891 - Personal history of nicotine dependence |
Coverage |
Beneficiary must meet all of the following:
|
Couseling Requirements |
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0297 |
Medical Nutrition Therapy (MNT)
HCPCS/CPT Codes |
|
---|---|
Frequency | First year: Three hours of one-on-one counseling Subsequent years: Two hours |
Coverage |
Beneficiary must meet all of the following:
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | No |
Pneumococcal Vaccine and Administration
HCPCS/CPT Codes |
|
---|---|
Frequency |
|
Diagnosis Code |
Z23 - Encounter for immunization |
Coverage | All Medicare beneficiaries are eligible |
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | No |
Prostate Cancer Screening
HCPCS/CPT Codes |
|
---|---|
Frequency | Annually |
Diagnosis Code |
Z12.5 - Encounter for screening for malignant neoplasm of prostate |
Coverage |
Male beneficiaries aged 50 and older
|
Payment |
|
Resources | |
Noridian Medicare Portal | Yes - G0103 |
Screening Mammography
HCPCS/CPT Codes |
|
---|---|
Frequency |
|
Diagnosis Code |
Z12.31 - Encounter for screening mammogram for malignant neoplasm of breast |
Coverage | All females aged 35 and older |
Facilities |
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - 77057 and G0202 |
Screening Pap Tests
HCPCS/CPT Codes |
|
---|---|
Frequency |
|
Diagnosis Code |
High Risk
Low Risk
|
Coverage |
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0123, G0143, G0144, G0145, G0147, G0148, P3000 and Q0091 |
Screening Pelvic Examinations
HCPCS/CPT Codes |
G0101 - Cervical or vaginal cancer screening; pelvic and clinical breast examination |
---|---|
Frequency |
|
Coverage |
All female Medicare beneficiaries Pelvic exam and Pap test can be performed during same encounter |
Exam Requirements |
Must include seven (7) of the 11:
Pelvic examination (with or without specimen collection for smears and cultures) including:
|
Diagnosis Code |
High Risk
Low Risk
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0101 |
Sexually Transmitted Infections (STIs) Screening and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
HCPCS/CPT Codes |
|
---|---|
Frequency |
|
Diagnosis Code |
|
Coverage |
Beneficiaries must meet all of the following criteria:
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | No |
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
HCPCS/CPT Codes |
G0389 - Ultrasound exam for AAA screening |
---|---|
Frequency |
Once in a lifetime |
Coverage |
Beneficiaries must meet both of the following criteria:
|
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0389 |
Resources
CMS has developed educational resources that are available for the provider community.
- CMS IOM, Publication 100-04, Chapter 18, Preventive and Screening Services - Internet Only Manual containing definition and listing of preventive and screening services.
- CMS Prevention General Information - This CMS website defines the preventive services and offers additional resources.
- CMS Preventive Services Educational Products - The CMS Medicare Learning Network ® (MLN) offers products, free of charge to view, download, print, and redistribute.
Last Updated Mon, 19 Oct 2020 21:18:41 +0000