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Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysm

Q: I have patients who meet the risk factors for ultrasound screening for abdominal aortic aneurysm, but since Medicare does not cover this service, these patients cannot afford to get the procedure. What should I do?

A: Medicare has historically not paid for preventive services, only adding a few at a time through legislative action. Congress did establish coverage for a ultrasound screening for abdominal aortic aneurysm beginning on January 1, 2007. However, Congress specified some requirements that may make it difficult to refer patients and for the physician reading the test to get paid.

The biggest obstacle to the coverage is that, in order to be paid, the patient must be referred for the screening during the Initial Preventive Physical Examination, also known as the "Welcome to Medicare" exam. This is the preventive visit that was introduced in 2005, covering a screening exam for patients in their first six months as a Medicare Part B beneficiary. The number of eligible patients who receive the "Welcome to Medicare" exam is quite low, however. This means that patients who have been on Medicare for more than six months and who have not had the screening exam cannot receive the benefit.

Q: Who is eligible to be referred for the benefit as paid by Medicare?

A: Beneficiaries who meet the conditions set forth by the U.S. Preventive Services Task Force (USPSTF) are eligible to be referred for the screening and have it covered by Medicare. The current guidelines allow payment for males between the ages of 65 and 75 who have smoked at least 100 cigarettes in their lifetime.

The regulation allows for additional Medicare beneficiaries to be eligible for this exam if USPSTF recommendations change in the future.

Q: Will any spending that comes from Medicare coverage of this screening service hurt physicians when Medicare calculates futural annual payment updates?

A: As a new benefit mandated by Congress, it will not be subject to budget neutrality requirements that would reduce the value of other services.

Page updated: 07/05/07

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