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CMS Initial Preventive Physical Examination Background Information and Resources for Screening Tools

Background

In the rules CMS published to implement the Congressionally established Initial Preventive Physical Exam, the agency defined this "welcome to Medicare exam" to include (among other things): a review of an individual's potential (risk factors) for depression; and a review of an individual's functional ability and level of safety. CMS stated that these assessments must be based on the use of an "appropriate screening instrument," but the agency chose not to define an appropriate screening instrument recognizing that the physician should be able to select the screening instrument. Accordingly, the CMS description of the depression screen and the functional ability/safety screen states that the physician may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.

In the introductory text to the specific CMS rules described above (and listed below), the agency elaborates that "any screening standardized screening test for depression, functional ability, and level of safety recognized by the American Academy of Family Physicians, American College of Physicians, the American College of Preventive Medicine, the American Geriatrics Society, the American Psychiatric Association, the USPSTF, or other recognized medical professional group would be acceptable for the purposes of meeting the 'appropriate screening instrument' guidelines."

Description of Necessary Screening to be included in the "Welcome to Medicare Exam" Benefit

Review of the individual's potential (risk factors) for depression, including past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the physician or other qualified nonphysician practitioner may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.

Review of the individual's functional ability, and level of safety, based on the use of an appropriate screening instrument, which the physician or other qualified nonphysician practitioner may select. Available standardized screening tests must be recognized by a national medical professional organization(s).

Review of the individual's functional ability and level of safety must include, at a minimum, a review of the following areas:

  • Hearing impairment, using appropriate screening questions or questionnaire.

  • Activities of daily living

  • Falls risk

  • Home safety

More detailed information on how to correctly code and bill for the initial preventative physical exam can be found in the January-February ACP Observer.

Page updated: 2009