Medicare Coverage of
Ultrasound Screening for Abdominal Aortic Aneurysms
(AAA) and Screening Fecal-Occult Blood Tests (FOBT) 82270-82274
Provider Types Affected
This MLN Matters Article is intended for physicians, physician assistants,
nurse practitioners and clinical nurse specialists submitting claims to
Medicare Administrative Contractors (MACs) for ultrasound screening for
Abdominal Aortic Aneurysms (AAA) and Screening fecal-occult blood tests (FOBT)
ordered for Medicare beneficiaries.
Provider Action Needed
Effective for dates for service on and after January 27, 2014, MACs shall pay
claims for ultrasound screening for AAA and screening FOBTs per the modified
requirements in 42 CFR 410.19 and 410.37. See the details of the changes in the
Background section below. Make sure that your billing staffs are aware of these
changes.
Background
Medicare Part B coverage of screening FOBTs and ultrasound screening for AAA is
covered for certain beneficiaries that meet eligibility requirements as
described in regulations. As part of the CY 2014 Physician Fee Schedule rule,
the Centers for Medicare & Medicaid Services (CMS) revised he Medicare Part
B coverage requirements for Ultrasound Screening for AAA (42 CFR 410.19) and
Screening FOBT (42 CFR 410.37).
As a result of CR8881, the following policy changes are effective for dates of
service on and after January 27, 2014:
• Ultrasound Screening for AAA : Coverage of AAA screening is
modified by eliminating the one year time limit with respect to the referral
for this service. This requiring them to receive a referral as part of the
Initial Preventive Physical Examination (IIPE, also commonly known as the
"Welcome to Medicare Preventive Visit"). The practitioner, or clinical
nurse specialist. All other coverage requirements for this service remain
unchanged, per 42 CFR 410.19.
• Screening FOBTS : In addition to the beneficiary's
attending physician, the beneficiary's attending physician assistant, nurse
practitioner, or clinical nurse specialist may furnish written orders for
screening FOBTs, per section 42 CFR 410.37(b). All other coverage requirements
for this service remains unchanged, per 42 CFR 410.37
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