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Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
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Related Articles
- Medicare Preventive Services Resource Guide
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Cardiovascular Disease Screening Tests
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.
Table of Contents
- Coverage Criteria
- HCPCS/CPT Coding
- Diagnosis Coding
- Who Can Perform?
- Cost Sharing
- Reimbursement
- Common Claim Denials
- Related Content
Coverage Criteria
All Medicare beneficiaries without apparent signs or symptoms of CVD are covered.
- Once every five years
- At least 59 months must have passed from the last covered screening test
Must be ordered by a physician or qualified NPP for CVD early detection. CVD risk factors include:
- Diabetes
- Family history of cardiovascular disease
- Diets high in saturated fats, cholesterol and salt or sodium
- History of previous heart disease
- Hypercholesterolemia (high cholesterol)
- Hypertension
- Lack of exercise
- Obesity
- Excessive alcohol use
- Smoking
- Stress
Beneficiary must fast for 12 hours prior to testing for the following covered tests:
- Total cholesterol
- Cholesterol test for high-density lipoproteins
- Triglycerides test
HCPCS/CPT Coding
- 82465: Cholesterol, serum or whole blood, total
- 83718: Lipoprotein, direct measurement; HDL cholesterol
- 84478: Triglycerides
- 80061: Lipid Panel (must include 82465, 83718 and 84478)
Diagnosis Coding
- ICD-10 Codes
- Z13.6
- Note: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service and contact your MAC for guidance.
Who Can Perform?
- Physician: doctor of medicine or osteopathy
- Qualified NPP
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denials
- Beneficiary received a covered lipid panel during past five years
- Beneficiary received same individual cardiovascular screening test(s) within past five years
Related Content
- CMS IOM Publication100-04, Medicare Claims Processing Manual, Chapter 18, Section 100
- MLN Matters® MM3411: MMA-Cardiovascular Screening Blood Tests
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 9/27/2024