In this week leading up to Father’s Day, we observe National Men’s Health Awareness Week.
Medicare offers a wide range of preventive services for its male beneficiaries.Identifying risk factors and utilizing screening tests for early detection can mean the difference between life and death.
Statistically many of the leading causes of death in males 65+ are due to preventable and/or highly treatable causes.
Centers for Disease Control and Prevention data for 2009 indicates that heart disease and cancer combined represent more than half of the deaths for this age group.
Colorectal and prostate cancer screenings are covered annually. Alcohol misuse, tobacco use and obesity are often linked to other cancers. Medicare benefits also provide for alcohol misuse screening and counseling, tobacco cessation counseling, and intense behavioral therapy for obesity.
For patients as risk for heart disease, you can utilize the cardiovascular disease screenings once every five years. It is known smoking and being overweight can significantly affect heart health; those preventive services as mentioned above are also applicable.
Take this week to have office staff review patient files for those males 65 and over that are due for their annual wellness visit and give them a call. By working together, we can ensure the optimum health and long life for the men in our lives.
The table below contains details on the above mentioned preventive services as well as others that are covered by Medicare based on eligibility requirements:
|
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 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/m2, 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. |
For More Information:
• MLN Preventive Services Educational Products for Health Professionals
• CMS Prevention website
• CMS Immunizations website
• CDC National Men’s Health Week
• Men’s Health Month website
