Wiki Codes Medicare will pay for AAA, G0389

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Codes Medicare will pay for AAA, G0389

Once upon a time, the abdominal aortic aneurysm (AAA) screening was tied to the Medicare Initial Preventive Physical Examination (IPPE), not because it was included in/part of the IPPE, but because you needed a referral at the time of the IPPE to allow coverage for the AAA screen. That’s not been the case since late 2014.
(see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8881.pdf for more information)

Use 2017 CPT® code 76706 Ultrasound, abdominal aorta, real time, with image documentation, screening study for abdominal aortic aneurysm (AAA) for AAA screening. Effective Jan. 1, 2017, CPT® code 76706 replaced HCPCS Level II code G0389 (see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9888.pdf). You would bill separately the IPPE because it is not tied to the AAA screening. The appropriate code to report the IPPE visit is G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment.

Orthocoderpgu

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Does anyone know if Medicare will pay for AAA that is not tied to the "Welcome to Medicare Exam"? Our docs got a new ultrasound machine which lists Risk Factors but all the info I get from Medicare is tied to the welcome to medicare exam. Do they pay for this outside of the welcome exam? Thanks for your thoughts.
 

jgf-CPC

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All centers will begin using the HCPCS code G0389 for Medicare patients only who are being scheduled for a screening of abdominal aortic aneurysm (AAA) instead of the codes 76700 (abdominal u/s) or 76770 (renal/aortic u/s). I have attached a PDF regarding the standards and limitations of this code from CMS. Please follow these guidelines when scheduling:

1) Is the test being ordered as a result of an IPPE (initial preventive physical exam), also known as the “Welcome to Medicare program?
2) Has the patient previously had one of these done before? (Medicare will only reimburse for one per lifetime)
3) Does the patient have one of the following necessary risk factors?
a) have a family history of abdominal aortic aneurysm
b) is a man age 65-75 who has smoked at least 100 cigarettes in his lifetime

Please take note that there is no Medicare Part B deductible, but coinsurance applies.
 

nzarilla

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But aren't there others that are not being delineated? The transmittal gives a broad statement that says "is a beneficiary who manifests other risk factors in a beneficiary category recommended for screening by the United States Preventative Services Task Force regarding AAA......" What diagnosis codes are included in that?
 

TamaraM

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Abdominal Aortic Aneurysm Screening-AAA

Provider Resources
This section provides information and resources on Medicare coverage, payment, and billing related to ultrasound screening for abdominal aortic aneurysm (AAA).

Medicare's coverage of ultrasound screening for Abdominal Aortic Aneurysm (AAA) is designated in section 5112 of the Deficit Reduction Act (DRA) of 2005 and effective for services furnished on or after January 1, 2007. Payment may be made for a one-time ultrasound screening for AAA for eligible beneficiaries who meet the following criteria:

Eligibility

To be eligible for this benefit, individuals must:

•Have taken advantage of the initial preventive physical examination, also known as the "Welcome to Medicare" visit;
•Have not been previously provided an ultrasound screening under the Medicare program; and
•Be included in at least one of the following risk categories:
◦the beneficiary has a family history of abdominal aortic aneurysm
◦the beneficiary is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
◦The beneficiary manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force (USPSTF) regarding AAA, as specified by the Centers for Medicare & Medicaid Services (CMS) through the national coverage determination process.
Coverage

One time coverage during the initial IPPE and a referral is made.
•There is no Medicare Part B deductible.
•Coinsurance or co-payment applies.
Billing:

•When a claim is filed for an AAA screening test, the appropriate HCPCS code G0389 (76700, current CPT code) and one of the following diagnosis codes (also called ICD-9-CM codes) must be reported:
o V15.82 -- Personal history of tobacco use presenting hazards to health.

o V17.4 -- Family history of other cardiovascular diseases.

o V81.2 -- Screening for other and unspecified cardiovascular conditions.


http://www.cms.gov/AAAScreen/02_ProviderResources.asp
 
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