Preventive Services

Preventive Services Guide


Ultrasound Screening for Abdominal Aortic Aneurysm

An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as specified by the Secretary of HHS, though the national coverage redetermination process) provided for the early detection of abdominal aortic aneurysms and includes a physician’s interpretation of the results.

Coverage Criteria

Ultrasound screening for AAA is a one-time benefit for all Medicare beneficiaries with certain risk factors for AAA.

  • Referral is required, but not as part of the IPPE
    • Referral required from:
      • Attending physician
      • Physician assistant
      • Nurse practitioner
      • Clinical nurse specialist
  • Risk factors include:
    • Family history of AAA
    • Male aged 65 to 75 who has smoked at least 100 cigarettes in lifetime
    • Beneficiary who manifests other risk factors
      • Beneficiary category recommended for screening by USPSTF regarding AAA, as specified by the Secretary of HHS, through the national coverage determination process

Documentation for AAA

  • Physician’s order
  • Patient included in one or more AAA risk categories
  • Patient asymptomatic

HCPCS/CPT Coding

  • 76706: Ultrasound, abdominal aortic, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
    • Modifiers TC, 26

Diagnosis Coding

Who Can Perform?

  • Provider/supplier authorized to provide covered ultrasound diagnostic services

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

Reimbursement

Nonparticipating Providers:

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Common Claim Denials

  • No referral for ultrasound screening for AAA
  • Second AAA billed for same beneficiary

Advance Beneficiary Notice of Noncoverage

  • If a second AAA ultrasound screening is billed or if any of the other statutory criteria for coverage are not met, the service would be denied as a statutory (technical) denial, not a medical necessity denial
  • If it cannot be determined whether or not the beneficiary has previously had an AAA screening, but all other statutory requirements have been met, the provider should issue the ABN

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Reviewed 9/27/2024