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Additional Services covered during wellness visit
Medicare covers a one-time only Abdominal Aortic Aneurysm (AAA) Screening for at-risk members when a referral for the screening is received as a result of the wellness exam. In 2014, this service is subject to member cost-sharing in most plans.
Medicare covers a one-time only Electrocardiogram (EKG) Screening for Medicare members. In 2014, this service is subject to member cost-sharing in most plans.
Any clinical laboratory tests or other diagnostic services that CMS recognizes and defines as medically necessary (as opposed to preventive) performed at the time of the wellness visit may be subject to a copayment or coinsurance. Refer to the CMS Policy that defines these guidelines, e.g., refer to the Medicare Physician Fee Schedule to determine if a service is covered by Medicare. A Status Indicator of ‘N’ reflects non-coverage. Therefore, the member is required to sign the Advanced Notice of Non Coverage (ANN) form prior to the service being provided by a contracting lab. Other reference sources in addition to Medicare Physician Fee Schedule include: National Coverage Determinations, Local Coverage Determinations, and NCCI Policy.
In general, screening lab work is not covered by Medicare (with a few exceptions as outlined in the list of covered preventive services below) and therefore not covered by our plan.
Common Preventive Services and Screenings
Physicians and other health care professionals may also provide and bill separately for screenings and other preventive services. All Medicare Advantage plans insured by UnitedHealthcare cover the following Medicare-covered preventive services at the same frequency as covered by original Medicare, except where otherwise noted, for a $0 copayment:
• Alcohol misuse screening and counseling
• Hepatitis B immunization
• Bone mass measurement HIV screening
• Breast cancer screening (mammograms)
• Cardiovascular screening
• Intensive behavioral therapy to reduce cardiovascular disease risk
• Cervical and vaginal cancer screening (Pap test and pelvic exam)2
• Medical nutrition therapy services
• Obesity screening and counseling1
• Colorectal cancer screening3 Pneumococcal shot
• Depression screening Prostate-specific antigen (PSA) test4
• Diabetes screening
• Flu shot
• Glaucoma tests (for those at high risk)
• Tobacco use cessation counseling
• Sexually transmitted infections screening and counseling
1 In accordance with Medicare guidelines, covered only in the primary care setting.
2 In 2014, coverage periodicity follows Medicare guidelines: covered annually for those at high risk and every two years for all other women.
3 For all Medicare Advantage plans insured by UnitedHealthcare, a colonoscopy that begins as a Medicarecovered screening service is subject to the $0 screening cost-share regardless of whether a polyp is found and/or removed during the procedure.
4 A DRE is subject to cost-sharing.
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