Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysms
(AAA) and Screening Fecal-Occult Blood Tests (FOBT) 82270-82274
Provider Types Affected
This MLN Matters Article is intended for physicians, physician assistants, nurse practitioners and clinical nurse specialists submitting claims to Medicare Administrative Contractors (MACs) for ultrasound screening for Abdominal Aortic Aneurysms (AAA) and Screening fecal-occult blood tests (FOBT) ordered for Medicare beneficiaries.
Provider Action Needed
Effective for dates for service on and after January 27, 2014, MACs shall pay claims for ultrasound screening for AAA and screening FOBTs per the modified requirements in 42 CFR 410.19 and 410.37. See the details of the changes in the Background section below. Make sure that your billing staffs are aware of these changes.
Background
Medicare Part B coverage of screening FOBTs and ultrasound screening for AAA is covered for certain beneficiaries that meet eligibility requirements as described in regulations. As part of the CY 2014 Physician Fee Schedule rule, the Centers for Medicare & Medicaid Services (CMS) revised he Medicare Part B coverage requirements for Ultrasound Screening for AAA (42 CFR 410.19) and Screening FOBT (42 CFR 410.37).
As a result of CR8881, the following policy changes are effective for dates of service on and after January 27, 2014:
• Ultrasound Screening for AAA : Coverage of AAA screening is modified by eliminating the one year time limit with respect to the referral for this service. This requiring them to receive a referral as part of the Initial Preventive Physical Examination (IIPE, also commonly known as the “Welcome to Medicare Preventive Visit”). The practitioner, or clinical nurse specialist. All other coverage requirements for this service remain unchanged, per 42 CFR 410.19.
• Screening FOBTS : In addition to the beneficiary’s attending physician, the beneficiary’s attending physician assistant, nurse practitioner, or clinical nurse specialist may furnish written orders for screening FOBTs, per section 42 CFR 410.37(b). All other coverage requirements for this service remains unchanged, per 42 CFR 410.37
