An Important Reminder About Preventive Screening Tests
February, American Heart Month, is a good reminder of the importance of heart health. It’s also a good time to remind health care professionals of certain Medicare benefits offered to beneficiaries for preventive care beyond the initial preventative physical examination (IPPE).
In particular, cardiovascular screening blood tests and smoking and tobacco cessation counseling are both separate billable services from the IPPE that physicians, non-physician practitioners (NPPs), and hospitals can offer their Medicare patients.
Covered cardiovascular screening blood tests include the following:
- Total Cholesterol Test
- Cholesterol Test for High-density Lipoproteins
- Triglycerides Test
These tests do not have to be obtained within the first six months of a patient’s enrollment to Medicare. Paid under the Medicare Clinical Laboratory Fee Schedule, a Medicare beneficiary qualifies for cardiovascular screening tests every five years, providing the tests are ordered by the treating physician or NPP, and the patient has no apparent signs or symptoms of cardiovascular disease.
The following CPT® codes should be used to report cardiovascular screening blood tests:
- 80061 Lipid panel
- 82465 Cholesterol, serum or whole blood, total
- 83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
- 84478 Triglycerides
Note: These tests should be performed as a panel; however, they are also available as individual tests.
The following diagnosis codes must be submitted on the claim when billing for cardiovascular screening:
- V81.0 Special screening for ischemic heart disease
- V81.1 Special screening for hypertension
- V81.2 Special screening for other and unspecified cardiovascular conditions
Medicare also provides coverage for smoking and tobacco-use cessation counseling for Medicare patients who:
- Use tobacco and have a disease or an adverse health effect found by the U.S. Surgeon General to be linked to tobacco use; or
- Are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on U.S. Food and Drug Administration (FDA) information.
In 2008, CPT® codes 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes and 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes were published in the Preventative Medicine section under Evaluation and Management services. These codes replaced temporary HCPCS Level II G codes G0375 and G0376.
Medicare will cover two cessation attempts a year, and each attempt may include a maximum of four intermediate (99406) or intensive (99407) sessions. Private payer coverage may vary.
In addition, report ICD-9-CM diagnosis code 305.1 Tobacco use disorder and the related condition or interference with the effectiveness of medications (eg, 140.x Malignant neoplasm of lip or 296.xx Episodic mood disorders). Remember that private payer benefits are subject to specific plan policies.
Both the screening and counseling services are Medicare Part B benefits for which beneficiaries pay nothing. There is no coinsurance or copayment and no deductible for these services.
For more information about heart disease, contact your local American Heart Association office. For more preventive services information covered by Medicare, look on the Centers for Medicare & Medicaid Services (CMS) Web site under Medicare/Prevention.