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Medicare Preventive Services

Beneficiary access to preventive services improved significantly in 2011.  This improved access results from the elimination of the deductible and coinsurance for most of the preventive services including the initial preventive physical examination (IPPE) and waiving the deductible for tests that begin as colorectal cancer screening tests but during the test become diagnostic or therapeutic.  Further, the Centers for Medicare & Medicaid Services (CMS) now covers an annual wellness visit (AWV), a service to be provided annually that augments the one-time IPPE service which includes personalized prevention plan services.  The AWV as determined by law, may include at least the following six elements:

  • Establish or update the individual's current medical and family history
  • List the individual’s current medical providers and suppliers and all prescribed medications
  • Record measurements of height, weight, body mass index, blood pressure and other routine measurements
  • Detect any cognitive impairment
  • Establish or update a screening schedule for the next 5 to 10 years including screenings appropriate for the general population, and any additional screenings that may be appropriate because of the individual patient’s risk factors
  • Furnish personalized health advice and appropriate referrals to health education or preventative services

A complete listing of the preventive services covered by Medicare, along with the 2013 Medicare Final Payment Schedule, can be accessed below.

Preventive Services Covered by Medicare

CMS Coverage of Preventive Services by CPT Code

Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2013