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
Category | Coverage and Benefit Resources |
---|---|
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 G0008 allows $30 (2022) |
Resources |
|
Roster Billing |
|
Noridian Medicare Portal | No |
Initial Preventive Physical Examination (IPPE)
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
HCPCS/CPT Codes |
|
Frequency | Annually First year: Before first screening, beneficiary must receive counseling and shared decision making visit (HCPCS G0296) Subsequent years: Beneficiary must receive written order furnished during appropriate visit with physician or non-physician practitioner. Counseling and shared decision-making optional. If the provider elects to provide counseling in subsequent years, include all counseling requirements indicated below. |
Diagnosis Code | F17.210-F17.219 - Nicotine dependence |
Coverage | Beneficiary must meet all of the following eligibility criteria:
Written orders must be documented in medical record and include:
|
Couseling Requirements | Before the beneficiary's first lung cancer low dose CT screening, the beneficiary must receive a counseling and shared decision-making visit that meets all of the following criteria and is appropriately documented in the medical record:
Subsequent annual lung cancer low dose CT screenings must include a written order. If the provider or non-physician practitioner elects to provide lung cancer screening counseling for the subsequent screening, all of the criteria from the initial counseling (above) must be documented. |
Payment | Copayment/coinsurance waived; Deductible waived |
Resources | |
Noridian Medicare Portal | Yes - G0297/71271 |
Medical Nutrition Therapy (MNT)
Category | Coverage and Benefit Resources |
---|---|
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 |
Monkeypox and Smallpox Vaccines and Administration
Category | Coverage and Benefit Resources |
---|---|
HCPCS/CPT Codes |
|
Payment | When the government provides vaccines at no cost, only bill for the vaccine administration. Beneficiary cost sharing will apply to the administration of the vaccine. |
Resources | CMS MLN Connects August 11, 2022 |
Pneumococcal Vaccine and Administration
Category | Coverage and Benefit Resources |
---|---|
HCPCS/CPT Codes |
|
Frequency |
|
Diagnosis Code | Z23 - Encounter for immunization |
Coverage | All Medicare beneficiaries are eligible |
Payment | Copayment/coinsurance waived; Deductible waived G0009 allows $30 (2022) |
Resources | |
Noridian Medicare Portal | Yes. HCPCS codes 90670 and 90732 (Pneumococcal Vaccines) will display up to 10 previous dates of service and with the rendering NPI. These codes will only be viewable if the beneficiary has Medicare Part B coverage. |
Prostate Cancer Screening
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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
Category | Coverage and Benefit Resources |
---|---|
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)
Category | Coverage and Benefit Resources |
---|---|
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 Tue, 15 Nov 2022 19:38:02 +0000