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 |