Know Medicare screening services fully – CPT and covered DX

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Summary of Medicare Screening Services

Possible Procedure/HCPCS Codes Coverage Patient Criteria Patient Financial Responsibility Provider Criteria Possible Diagnosis Codes
Screening Pelvis Examination
G0101 Every 2 years Not high risk 20 % allowable No Part B deductible None stated V76.2, V76.47, V76.49, V72.31
Annually High risk V15.89
Collection of Pap Smear Specimen
Q0091 Every 2 years Not high risk 20 % allowable No Part B deductible None stated V76.2, V76.47, V76.49, V72.31
Annually High risk V15.89
Screening Hemoccult
82270 G0328 Annually >50 years old None None stated V76.51, V76.41
Screening Mammography
77057, +77052 G0202 Annually >40 years old 20 % allowable No Part B deductible None stated V76.12, V76.11
Screening Bone Mass Measurement
77078, 77079, 77080, 77081, 77083, 76977, G0130 Once every 24 months Patients at risk 20% allowable Deductible applies Test ordered by physician or qualifed non physician practitioner who is treating patient. Determined by Local Carriers*
Initial Preventive Physical Examination (Welcome to Medicare Examination)
G0402, G0403, G0404, G0405 Once Within first 12 months of Medicare coverage 20% allowable Deductible waived, but co-insurance provision apply Test ordered by physician or qualifed non physician practitioner who is treating patient. V070.0
Diabetes Screening
82947, 82950, 82951 Twice in 12 month period Patients at risk None None stated V77.1
Cardiovascular Screening Blood Test
82465, 84478, 83718, 80061 Every 5 years All Medicare beneficiaries None Test must be ordered by physician and used in management of patient V81.0, V81.1, V81.2
Tobacco Use Cessation Counseling
99406, 99407 2 cessation attempts in 12 month period (1 attempt=up to 4 sessions) Patient has condition or is receiving treatment that is being adversely affected by tobacco use 20% allowable Deductible applies Provided by a physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker Use code indicating patient’s condition or treatment affected by tobacco use