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Thread: Codes Medicare will pay for AAA, G0389

  1. #1

    Cool Codes Medicare will pay for AAA, G0389

    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.

  2. #2
    Join Date
    Apr 2007
    Posts
    77

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    Pls follow the link. It would be helpful.

    https://www.cms.gov/transmittals/downloads/R1113CP.pdf

    Thanks,
    Abdul Saleem CPC

  3. #3
    Join Date
    Apr 2007
    Location
    Columbus GA
    Posts
    571

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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.

  4. #4

    Default

    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?

  5. #5

    Default 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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