Medicare CPT codes

Medicare Part B Covered CPT codes



Generally we cant say which CPT codes are covered or not. If differs from each state and it has to be determined by local Medicare but we can give by which type of services are covered or not.

Medicare Part B helps pay medically necessary services such as:

•    Doctors' services
•    Practitioners' services (under limited circumstances)
•    Outpatient hospital care
•    Diagnostic tests
•    Durable medical equipment
•    Ambulance services
•    Medical and surgical services, including anesthesia
•    Diagnostic tests and procedures that are part of treatment
•    Radiology and pathology services by doctors (hospital inpatient or outpatient)
•    Treatment of mental illness
•    Other services such as: Drugs and biological that cannot be self-administered, transfusions of blood and blood components, medical supplies, physical and occupational therapy and speech pathology services, and services of the office nurse.

Medicare Part B Covered Preventive Services



•    Bone Mass Measurement for certain people who are at risk of losing bone mass
•    Colorectal Cancer Screening
1.    Fecal Occult Blood Test once every 12 months
2.    Flexible Sigmoidoscopy once every 48 months
3.    Colonoscopy once every 24 months for people at high risk for colon cancer
4.    Barium Enema (physician can substitute for sigmoidoscopy or colonoscopy
•    Diabetes Services for people who have diabetes (insulin users and non-users)
1.    Coverage for glucose monitors, test strips, and lancets (coverage through DMERC)
2.    Diabetes self-management training
•    Mammography Screening for all women over age 40, once every 12 months
•    Pap Smear and Pelvic Examination for all women, once every 36 months (beginning July 1, 2001, once every 24 months) and for women with high risk for cervical cancer or previous abnormal Pap Smear , once every 12 months
•    Prostate Cancer Screening for men aged 50 and over;
1.    Digital Rectal Examination every 12 months
2.    Prostate Specific Antigen (PSA) Test once every 12 months
•    Medical Nutrition Therapy (MNT) is a covered benefit effective January 1, 2002, for patients with diabetes or renal disease.
•    Glaucoma Screening is a covered benefit effective January 1, 2002, for individuals with diabetes, a family history of glaucoma, or others determined to be at "high risk" for glaucoma.
•    Vaccinations
1.    Flu vaccination once a year in the fall and winter
2.    Pneumonia vaccination (one lifetime)
3.    Hepatitis B vaccination for people with medium to high risk for hepatitis

Non-Covered Services



•    Routine physical examinations and tests directly related to such examinations
•    Most routine foot care and dental care
•    Examinations for prescribing or fitting eyeglasses or hearing aids
•    Immunizations (except pneumococcal vaccinations, influenza vaccinations, hepatitis B for certain persons at risk or immunizations required because of an injury or immediate risk or infection)
•    Cosmetic surgery, unless it is needed because of accidental injury or to improve the function of a malformed part of the body
•    Services related to cosmetic surgery


 If you want know particular CPT covered or not. Just go to local Medicare website and go to the fee schedule page. If you find the CPT listed there then it means particular CPT is covered by Medicare. For example go to the below website and find it.

Florida Medicare fee schedule

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1 comment:

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