Service

Procedure Code(s)

Coverage

Frequency

Abdominal Aortic Aneurysm Screening

G0389-U/S exam AAA Screening

Any beneficiaries with certain risk factors and a referral resulting from an IPPE visit.

Once in a lifetime

Alcohol Misuse Screening and Counseling

G0442-Annual screening, 15 min.

G0443-Brief face-to-face behavioral counseling for misuse, 15 min.

For screening: all beneficiaries.

For misuse, furnished by PCP: all competent beneficiaries.

G0442-Once annually

G0443-4 times per year

Annual Wellness Visit (AWV)

G0348-Initial Visit

G0349-Subseqeunt Visit

Any beneficiary that has been effective for Part B for at least 1 year.

G0348- Once in a lifetime

G0349- Once annually

Colorectal and Prostate Cancer Screenings

G0104-Flexible Sigmoidoscopy or G0106-Barium Enema

G0105-Colonoscopy

(high risk) or

G0120-Barium Enema

G0121-Colonoscopy (not high risk)

G0328-Fecal Occult Blood Test immunoassay

82270- Fecal Occult Blood Test by peroxidase activity.

Any beneficiary aged 50 or over who are at normal or high risk for developing

Colo-rectal cancer.

G0328/82270-Once annually

G0104-Once every 4 years or 120 months after G0121

G0121-Once every 10 years or 48 months after G0104 or every 24 months for high risk

G0106/G0120-Once every 48 months or 24 months for high risk.

Cardiovascular Disease Screenings

80061-Lipid Panel

82465-Cholesterol

83718-Lipoprotein

84478-Triglycerides

Any beneficiaries w/o signs or symptoms of cardiovascular disease

Every 5 years

Depression Screening

G0444-Annual screening, 15 min.

Any beneficiary as furnished by PCP with proper support staff.

Once annually

Diabetes Screening

82947-Blood Glucose; quantitative

82950-Glucose;post-glucose dose

82951-Glucose;3 specimen tolerance test

Any beneficiaries with risk factors or diagnoses with pre-diabetes.

Once annually if no pre-diabetes. 

Twice annually with pre-diabetes.

HIV Screening

G0432-Infectious agent by EIS technique

G0433-Infectious agent by ELISA technique

G0435-Infectious agent by rapid antibody test

Any beneficiaries at increased risk for HIV infection or pregnant.

Annually for high risk beneficiaries. 

Three times per pregnancy.

Immunizations (Seasonal Influenza, Pneumococcal, and Hepatitis B)

90654-90657, 90660-90662, Q2034-Q2039-Influenza Virus Vaccine/ G0008 administration

90669-90670,90732-Pneumococcal Vaccine/

G0009-Administration

90740,90743-90744, 90746-90747-Hepatitis B Vaccine/G0010 administration

Influenza and Pneumococcal: all beneficiaries.

Hepatitis B:i any beneficiaries at intermediate or high risk for

Influenza- Once per season.

Pneumococcal- Once in a lifetime.

Hepatitis B- Scheduled dosages as required.

Intensive Behavioral Therapy for Cardiovascular Disease

G0446-IBT to reduce cardiovascular disease risk; individual, face-to-face, bi-annual, 15 min.

Furnished by PCP: Male beneficiaries aged 45-79-encouraging aspirin use, adults aged 18 or older- screening for hypertension, adults with risk factors- promoting a healthy diet

Once annually

Intensive Behavioral Therapy for Obesity

G0447-Behavioral counseling, face-to-face, 15 min.

Beneficiaries with BMI greater than or equal to 30 kg/m^2, furnished by PCP.

One visit per week in first month.

One visit every 2 weeks, months 2-6.

One visit per month, months 7-12.

Prostate Cancer Screening

G0102-Digital rectal exam

G0103-Prostate Specific Antigen test

All male beneficiaries aged 50 and older.

Once annually

Tobacco Use Cessation Counseling

G0436-Counseling for the asymptomatic patient; intermediate >3min. up to 10 min.

G043-Couseling for the asymptomatic patient; intensive, > 10 min.

All outpatient and inpatient beneficiaries.

Two cessation attempts per year: attempt =  max of four sessions, up to eight sessions in 12 months.