June is Men’s Health Month: Billing Preventive Services in the PCP Setting

CMS recently published an article on raising awareness of men’s health issues and preventive services – in light of June being Men’s Health Month. With the revamped Medicare policy on preventive services – for which the Affordable Care Act contains provisions that have allowed Medicare to cover many new preventive services at no charge to the patient – it is important that every medical provider know which services are covered, and when they can be billed. It is a win-win from a medical practice perspective, as the patient’s receive optimal care, and the provider can receive reimbursement for the valuable services rendered.

We recommend that every Primary Care Provider include a checklist of Medicare covered preventive services (the Medicare Quick Reference Preventive Services Information Sheet is a perfect tool) in the front of each Medicare patient’s chart. This will allow both the patient and provider to track his or her preventive services and ensure that no opportunity is missed.

The below list (with the addition of relevant CPT’s) and resources come directly from CMS’s Medicare Fee-For-Service Provider e-News for 06/06/2013):

Medicare-Covered Preventive Services of Particular Interest to Men

Medicare provides coverage of a wide range of preventive services, subject to certain eligibility and coverage requirements that are especially meaningful to men in helping them prevent and detect disease, including but not limited to:

  • Alcohol Misuse Screening and Counseling (G0442, G0443)
  • Abdominal Aortic Aneurysm Screening (G0389)
  • Annual Wellness Visit (providing personalized prevention plan services) (G0438, G0439)
  • Colorectal and Prostate Cancer Screenings (G01404, G0105, G0106, G0120, G0121, G0328, 82270)
  • Cardiovascular Disease Screenings (80061, 82465, 83718, 84478, G0446)
  • Depression Screening (G0444)
  • Diabetes Screening (82947, 82950, 82951, G0108, G0109)
  • HIV Screening (G0432, G0433, G0435)
  • Immunizations (Seasonal Influenza, Pneumococcal, and Hepatitis B)
  • Intensive Behavioral Therapy for Cardiovascular Disease (G0446)
  • Intensive Behavioral Therapy for Obesity (G0447)
  • Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling to (HIBC) to Prevent STIs
  • Tobacco Use Cessation Counseling (G0436, G0437)


How Can You Help?

As a provider of health care to people with Medicare you can help your patients make the most of their benefits by talking with them about their risk factors for disease and the importance of prevention and early detection and encouraging them to take advantage of the preventive services that are most appropriate for them. Your recommendation can help make a difference in the overall quality of life for the fathers, sons, brothers, and uncles, under your care.

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