OTHER MEDICARE PREVENTIVE SERVICES
Following are brief descriptions of other preventive services covered by Medicare and sometimes provided by obstetrician/gynecologists.
Bone Mass Measurements
Medicare covers bone mass measurements every two years for qualified individuals. The patient is responsible for meeting her Medicare Part B deductible and for her 20% co-payment.
A “qualified individual” meets at least one of these medical indications:
• Estrogen-deficient and at clinical risk for osteoporosis
• Vertebral abnormalities as demonstrated by an x-ray
• Receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5.0 mg of prednisone or greater, per day, for more than 3 months
• Has a diagnosis of primary hyperparathyroidism
• Being monitored to assess the response to or efficacy of an FDA – approved osteoporosis drug therapy
Medicare may pay for more frequent screenings when medically necessary. Examples include, but are not limited to, the following medical circumstances:
• Monitoring beneficiaries on long-term (more than 3 months) glucocorticoid (steroid) therapy
• Confirming baseline BMMs to permit monitoring of beneficiaries in the future
Procedure Codes
Medicare allows the physician to choose the screening test. As of January 1, 2007, the CPT/HCPCS coding options are:
77078 Computed tomography, bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77079 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77080 Dual energy x-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
77081 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77083 Radiographic absorptiometry (photodensitometry, radiogrammetry), one or more sites
76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method
G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites, appendicular skeleton (peripheral; e.g., radius, wrist, heel)
Diagnosis Codes
Local carriers determine the ICD-9-CM diagnostic codes that they will accept as supporting these indications. The test must be ordered by a physician or a qualified nonphysician practitioner who is treating the patient. Qualified nonphysician practitioners include physician assistants, nurse practitioners, clinical nurse specialists, and nurse-midwives. The test results must be required as part of the patient’s evaluation and/or formulation of a treatment plan.
