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
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)
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.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
CPT CODE and description 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by ...
CPT CODE and Description 97001 - Physical therapy evaluation Average fee payment $70 - $80 97002 - Physical therapy re-evaluation Ave...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Here is the big list of Medical terminology abbreviation @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial ...
Place of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided. Place...
Complete Blood Count (CBC) Testing A complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...