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This section provides information and resources on Medicare coverage, payment, and billing related to ultrasound screening for abdominal aortic aneurysm (AAA). Medicare's coverage of ultrasound screening for Abdominal Aortic Aneurysm (AAA) is designated in section 5112 of the Deficit Reduction Act (DRA) of 2005 and effective for services furnished on or after January 1, 2007. Payment may be made for a one-time ultrasound screening for AAA for eligible beneficiaries who meet the following criteria: Eligibility To be eligible for this benefit, individuals must: Have taken advantage of the initial preventive physical examination, also known as the "Welcome to Medicare" visit; - Have not been previously provided an ultrasound screening under the Medicare program; and
- Be included in at least one of the following risk categories:
- the beneficiary has a family history of abdominal aortic aneurysm
- the beneficiary is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
- The beneficiary manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force (USPSTF) regarding AAA, as specified by the Centers for Medicare & Medicaid Services (CMS) through the national coverage determination process.
Coverage - One time coverage during the initial IPPE and a referral is made.
- There is no Medicare Part B deductible.
- Coinsurance or co-payment applies.
Billing: - When a claim is filed for an AAA screening test, the appropriate HCPCS code G0389 (76700, current CPT code) and one of the following diagnosis codes (also called ICD-9-CM codes) must be reported:
o V15.82 -- Personal history of tobacco use presenting hazards to health. o V17.4 -- Family history of other cardiovascular diseases. o V81.2 -- Screening for other and unspecified cardiovascular conditions.
Page Last Modified: 02/03/2009 9:26:17 AM
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