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Medicare Preventive Services Education Tool Revised

Published on 

Wednesday, February 21, 2024

 | Billing 
 | Coding 
 | Documentation 
 | Medicare Coverage 

Did You Know?

Through the Medicare Learning Network (MLN), CMS has developed an interactive education tool titled Medicare Preventive Services (MLN006559 January 2024). This tool is meant to help providers properly provide and bill Medicare prevention services (i.e., bone mass measurement, colorectal screening, lung cancer screening).

 

For each Preventive Service listed in the tool, you will find the following information as applicable to the service:

  • National Coverage Determination (NCD),
  • HCPCS and CPT codes specific to the service provided,
  • ICD-10-CM diagnosis codes,
  • Telehealth eligibility,
  • Coverage requirements,
  • Frequency requirements, and
  • Medicare Beneficiary (patient) cost sharing.

     

    You will also find answers to the following questions:

  • How do I determine the last date a patient got a preventive service, so I know if they’re eligible to get the next service and it won’t deny due to frequency edits?
  • When can CMS add new Medicare preventive services?
  • My patients don’t follow up on routine preventive care. How can I help them remember when they’re due for their next preventive service?
    • CMS provides a link to a Preventive Services Checklist that you can give your patients.
    • Note, CMS also highlights preventive services with an apple in the official U.S. government Medicare Handbook, Medicare and You. You will find information about preventive services in the 2024 Edition of this handbook on pages 30-55.
  • What’s a primary care setting?

     

    Why It Matters?

    This tool was revised in January 2024. Following are two examples of what has been revised:  

     

    Annual Wellness Visit

    New HCPCS code G0136 (Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes) has been added as well as the following “Other Notes:”

  • The implementation date for SDOH Risk Assessment claims is July 1, 2024,
  • The billing HCPCS code is G0136,
  • Add modifier 33 to an SDOH, G0136, performed on the same day as the Annual Wellness Visit to waive copayment and deductible,
  • G0136 is covered once a year with copayment and deductible waived, and
  • The AWV can be an optional community health integration (CHI) initiating visit when the provider identifies any unmet SDOH needs that prevent the patient from doing the recommended personalized prevention plan.

 

Flu Shot

Starting January 1, 2024, Medicare pays an additional payment for in-home flu shot administration under certain circumstances.

 

What Can You Do?

  • Read all the revisions made to this tool in January in the February 15, 2024 edition of MLN Connects,
  • Use this tool to identify service specific applicable coverage requirements (NCD), HCPCS/CPT codes, and ICD-10-CM diagnosis codes, and
  • Share this tool with key stakeholders at your facility.
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.