May 19, 2014
Preventive and Screening Services: Overview of Coverage under Medicare
Medicare covers a variety of preventive and screening services. Some preventive services require that certain criteria or frequency requirements be met.
- The CMS Preventive Services Web page
provides helpful information regarding all potentially covered preventive services for Medicare beneficiaries. This web page is a great starting point for further research about specific types of preventive services that may be covered under Medicare. - Refer to this handy CMS Medicare Learning Network Preventive Services Quick Reference Chart
for a summary of preventive services and applicable criteria for coverage.
Flu and Pneumonia Vaccines
Medicare pays for a seasonal flu shot for Medicare fee-for-service beneficiaries. There is no coinsurance amount and flu shots are not subject to the annual deductible, if the vaccine is provided by a Medicare-enrolled provider. In general, Medicare covers a pneumonia vaccine once in a patient's lifetime. Additional vaccinations may be covered based on risk or if the beneficiary's vaccination status is uncertain.
Helpful resources from the CMS Medicare Learning network include:
Annual Wellness Visit (AWV) and Initial Preventive Physical Examination (IPPE)
Medicare covers an Annual Wellness Visit (AWV) for beneficiaries who are no longer within 12 months of the effective date of their initial Medicare Part B coverage period and who have not received either an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months. Requirements for the initial AWV are different from requirements for subsequent AWVs.
Medicare also covers an Initial Preventive Physical Examination (IPPE) for all newly-enrolled beneficiaries, within 12 months of the effective date of their first Medicare Part B coverage. The IPPE is a one-time benefit per beneficiary. The IPPE includes seven required components and is not the same as a "routine physical exam."
Helpful resources include the following publications from the CMS Medicare Learning Network:
- Providing the Annual Wellness Visits (AWV)
- Quick reference chart: The ABCs of Providing the Annual Wellness Visit (AWV)
- Required components for IPPEs and how to help beneficiaries prepare: Expanded Benefits: Initial Preventive Physical Examination; Ultrasound Screening for Abdominal Aortic Aneurysm; Cardiovascular Screening Blood Tests
- The ABCs of Providing the Initial Preventive Physical Examination
Screening for Alcohol Abuse
Medicare covers annual screening for alcohol misuse. Medicare also covers up to 4 "brief face-to-face counseling interventions" in a 12-month period for those who screen positive.
Refer to these CMS Medicare Learning Network publications for more information:
Depression Screening
Medicare covers annual screening for depression, up to 15 minutes, for Medicare beneficiaries, in primary care settings that have staff-assisted depression care support in place to ensure accurate diagnosis, effective treatment, and follow-up. Other requirements also apply. For more information, refer to the CMS Medicare Learning Network publication "Screening for Depression."
Other Screening
Other helpful resources from the CMS Medicare Learning Network include:
- Various publications available in the CMS Medicare Learning Network catalog (refer to the catalog for the most up-to-date materials)
- For help explaining coverage of preventive services to your Medicare patients, refer to the Medicare.gov website.
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