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MIR-2007 04B, April 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Reminder – Medicare Now Provides Coverage for Eligible Medicare Beneficiaries of a One-Time Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) When Referred for this Screening as a Result of the Initial Preventive Physical Examination (“Welcome to Medicare” Physical Exam) (SE0711)
Provider Types Affected
All Medicare fee-for-service (FFS) physicians, providers, suppliers, and other health care professionals, who furnish or provide referrals for and/or file claims for the initial preventive physical examination (IPPE) and the ultrasound screening for abdominal aortic aneurysms (AAA)
Provider Action Needed
This article conveys no new policy information. This article is for informational purposes only and serves as a reminder that Medicare provides coverage of a one-time initial preventive physical examination and a one-time preventive ultrasound screening for abdominal aortic aneurysms subject to certain coverage, frequency, and payment limitations. The Centers for Medicare & Medicaid Services (CMS) needs your help to get the word out and to encourage eligible beneficiaries to take full advantage of these benefits and all preventive services and screenings covered by Medicare.
Background
In January 2005, the Medicare program 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, also referred to as the “Welcome to Medicare” physical exam, for all Medicare beneficiaries whose Medicare Part B effective date began on or after January 1, 2005.
On January 1, 2007, Medicare further expanded the number of preventive benefits, as provided for in Section 5112 of the Deficit Reduction Act (DRA) of 2005, to include coverage under Medicare Part B of a one-time preventive ultrasound screening for the early detection of abdominal aortic aneurysms (AAA) for at risk beneficiaries as part of the IPPE. Both benefits (the IPPE and AAA) are subject to certain eligibility and other limitations.
The information in this Special Edition MLN Matters article reminds health care professionals that Medicare now pays for these benefits as well as a broad range of other preventive services and screenings. CMS needs your help to ensure that patients new to Medicare receive their “Welcome to Medicare” physical exam within the first six months of their effective date in Medicare Part B and those beneficiaries at risk for AAA receive a referral for the preventive ultrasound screening as part of their “Welcome to Medicare” physical exam.
Benefit Coverage Summary
The Initial Preventive Physical Examination (“Welcome to Medicare” Physical Exam)
Effective for dates of service on or after January 1, 2005: Medicare beneficiaries whose Medicare Part B effective date is on or after January 1, 2005, are covered for a one-time IPPE visit. The IPPE 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 (E/M) service that includes the following seven components:
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A review of an individual’s medical and social history with attention to modifiable risk factors,
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A review of an individual’s potential (risk factors) for depression,
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A review of the individual’s functional ability and level of safety,
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An examination to include an individual’s height, weight, blood pressure measurement, and visual acuity screen,
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Performance of an electrocardiogram (EKG) and interpretation of the EKG,
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Education, counseling, and referral based on the results of the review and evaluation services described in the previous five elements, and
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Education, counseling, and referral (including a brief written plan such 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).
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The Part B deductible and coinsurance/copayment apply to this benefit.
Note : The deductible does not apply for an IPPE provided in a Federally Qualified Health Center (FQHC). Only the coinsurance/copayment applies.
Other preventive services and screenings covered under Medicare Part B include: Adult immunizations (flu, pneumococcal, and hepatitis B), bone mass measurements, cardiovascular screening, diabetes screening, glaucoma screening, screening mammograms, screening Pap test and pelvic exam, colorectal and prostate cancer screenings, diabetes self-management training, medical nutrition therapy for beneficiaries diagnosed with diabetes or renal disease, and smoking and tobacco-use cessation counseling. Benefits are subject to certain eligibility and other limitations.
NOTE: The IPPE/”Welcome to Medicare” physical exam does not include any clinical laboratory tests. The physician, qualified nonphysician practitioner, or hospital may also provide and bill separately for the preventive services and screenings that are currently covered and paid for by Medicare Part B. (See the Additional Information section below for links to MLN Matters articles MM3771 and MM3638, which provide detailed coverage criteria and billing information about the IPPE benefit.)
Preventive Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)
Effective for dates of service on or after January 1, 2007, Medicare will pay for a one-time preventive ultrasound screening for AAA for beneficiaries who are at risk (has a 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 result of their “Welcome to Medicare” physical exam. There is no Part B deductible applied to this benefit, but coinsurance/copayment applies.
IMPORTANT NOTE: Only Medicare beneficiaries who receive a referral from their physician or other qualified nonphysician practitioner for the preventive ultrasound screening, as part of their “Welcome to Medicare” physical exam, will be covered for the AAA benefit. (See the Additional Information section below for a link to MLN Matters article MM5235, which provides detailed coverage criteria and billing information about the AAA benefit.)
Additional Information
For more information about Medicare’s coverage criteria and billing procedures for the AAA and IPPE benefits, refer to the following MLN Matters articles:
CMS has also developed a variety of educational products and resources to help health care professionals and their staff, become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
- The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for all provider specific educational products related to preventive services. The Web page is located at http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
 on the CMS Web site.
- The CMS Web site provides information for preventive service covered by Medicare. Visit http://www.cms.hhs.gov , select “Medicare,” and scroll down to “Prevention.”
For products to share with your Medicare patients, visit http://www.medicare.gov/ on the Web.
Flu Shot Reminder - It’s Not Too Late to Give and Get the Flu Shot!
The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf  .
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: SE0711
Related Change Request (CR) #: N/A
Effective Date: N/A
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