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Preventive Services and Screenings Covered by Medicare and Waiver of Coins/Copay/Dedt
• Abdominal Aortic Aneurysm Screening
• Alcohol Misuse Screening and Behavioral counseling Intervention in Primary Care
• Annual Wellness Visit (Including Personalized Prevention Plan Services)
• Bone Mass Measurements
• Cancer Screenings
• Breast Cancer (mammograms and clinical breast exam)
• Cervical and Vaginal Cancer (pap test and pelvic exam [includes the clinical breast exam])
• Colorectal Cancer
o Fecal Occult Blood Test
o Flexible Sigmoidoscopy
o Barium Enema
• Prostate (PSA blood test and Digital Rectal Exam)
• Cardiovascular Disease Screening
• Depression Screening in Adults
• Diabetes Screening
• Diabetes Self-Management Training
• Glaucoma Screening
• Human Immunodeficiency Virus (HIV) Screening
• Immunizations (Seasonal Influenza, Pneumococcal, and Hepatitis B)
• Initial Preventive Physical Examination (IPPE) (also commonly referred to as the “Welcome to Medicare” Preventive Visit)
• Intensive Behavioral Therapy for Cardiovascular Disease
• Intensive Behavioral Therapy for Obesity
• Medical Nutrition Therapy (for beneficiaries with diabetes or renal disease)
• Sexually Transmitted Infections (STIs) Screening and High-Intensity Behavioral Counseling (HIBC) to prevent STIs
• Tobacco-Use Cessation Counseling
As a result of the Affordable Care Act, Medicare now covers many of these services without cost to patients, including the Annual Wellness Visit that was created under the Affordable Care Act.
Waiver of Coinsurance,Copayment and Deductible for Preventive Services and Screenings
The coinsurance or copayment represents the beneficiary’s share of the payment to the provider or s
upplier for furnished services. Coinsurance generally refers to a percentage (for example, 20 percent) of the Medicare payment rate for which the beneficiary is liable and is applicable under the PFS, while copayment generally refers to an established amount that the beneficiary must pay that is not necessarily related to a particular percentage of the Medicare payment, and is applicable under the hospital Outpatient Prospective Payment System (OPPS).
Not all preventive services allowed in Medicare and recommended by the USPSTF have a Grade of A or B, and therefore, some of the preventive services do not meet the criteria in sections 1833(a)(1) and (b)(1) of the Act for the waiver of deductible and coinsurance.
For Carriers/AB MACs, Part B of Medicare pays 100 percent of the Medicare allowed amount for pneumococcal vaccines and influenza virus vaccines and their administration. Part B deductible and coinsurance do not apply for pneumococcal and influenza virus vaccine.
Part B of Medicare also covers the hepatitis B vaccine and its administration. Part B deductible and coinsurance do apply for hepatitis B vaccine. State laws governing who may administer pneumococcal and influenza virus vaccinations and how the vaccines may be transported vary widely. Medicare contractors should instruct physicians, suppliers, and providers to become familiar with State regulations for all vaccines in the areas where they will be immunizing.
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