FAQs on Preventive Services
CMS has posted 27 FAQs for Providers/Suppliers of preventive services for traditional Medicare to the Medicare Learning Network® Products Preventive Services webpage; to access the entire list of 27 FAQs, scroll to the “Related Links Inside CMS” section at http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and select “Preventive Services FAQs.” Or, find the answer to an individual FAQ below.
Annual Wellness Visit (AWV)
- Who can perform the AWV? Read the answer.
- Is the AWV the same as a beneficiary’s yearly physical? Read the answer.
- Are clinical laboratory tests part of the AWV? Read the answer.
- Is there a deductible or coinsurance/copayment for the AWV? Read the answer.
- Can a separate Evaluation and Management (E/M) service be billed at the same visit as the AWV? Read the answer.
- Are the “new” preventive services codes for the annual Medicare wellness visit included in applicable 2011 Physician Quality Reporting System measures? Read the answer.
Initial Preventive Physical Examination (IPPE)
- Is the IPPE the same as a beneficiary’s yearly physical? Read the answer.
- Who can perform the IPPE? Read the answer.
- Are clinical laboratory tests part of the IPPE? Read the answer.
- Is there a deductible or coinsurance/copayment for the IPPE? Read the answer.
- If a beneficiary enrolled in Medicare in 2010, can he or she have the IPPE in 2011 if it was not performed in 2010? Read the answer.
- Can a separate Evaluation and Management (E/M) service be billed at the same visit as the IPPE? Read the answer.
Medicare Immunization Billing (Seasonal Influenza Virus, Pneumococcal, and Hepatitis B)
- Does a Part B deductible or coinsurance apply to adult immunizations covered by Medicare? Read the answer.
- If a beneficiary receives a seasonal influenza virus vaccination more than once in a 12-month period, will Medicare still pay for it? Read the answer.
- Are HCPCS codes Q2035 and Q2039 payable by Medicare? Read the answer.
- Will Medicare pay for the pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history? Read the answer.
- Does Medicare cover the hepatitis B vaccine for all Medicare beneficiaries? Read the answer.
- When a beneficiary receives both the seasonal influenza virus and pneumococcal vaccines on the same visit, would a provider continue to report separate administration codes for each type of vaccine? Read the answer.
- Can the seasonal influenza virus, pneumococcal, and hepatitis B vaccines all be roster billed? Read the answer.
- What is a mass immunizer? Read the answer.
- Do providers that only provide immunizations need to enroll in the Medicare Program? Read the answer.
- May a single roster claim be submitted containing information for both the pneumococcal and seasonal influenza virus vaccines when the vaccines are administered on the same visit? Read the answer.
- End-Stage Renal Disease (ESRD) dialysis facilities currently bill for the flu, pneumonia, and hepatitis B vaccines. Will the administration of these vaccines also remain separately payable after Sat Jan 1, 2011? Read the answer.
- How should a provider that is not enrolled in Medicare bill for the flu vaccine? Read the answer.
- How should the Physician Quality Reporting Initiative influenza immunization measure #110 (Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old) be reported for patients seen outside of the flu season (September through February)? What if the flu immunization was administered by another provider? Read the answer.
Colorectal Cancer Screening
- Do the Medicare deductible and standard coinsurance apply for colorectal cancer screening services under the revised Ambulatory Surgical Center payment system? Read the answer.
Smoking Cessation Counseling
- What are the two CPT codes for smoking and tobacco use cessation counseling services that replace the temporary Healthcare Common Procedure Coding System (HCPCS) G codes (G0375 and G0376) previously used for billing these services? Read the answer.