Medical Billing: Key Medicare Benefits for Men’s Health

For those providers servicing Medicare beneficiaries, Men’s Health Awareness Week is a good time for you to re-familiarize yourself with the wide range of covered preventive services. Identifying risk factors and utilizing screening tests for early detection can mean the difference between life and death.

As demonstrated by the chart below, several of leading causes of death in males age 65 and over in the United States, are routinely linked to preventable and /or highly treatable causes. This data was reported by Centers for Disease Control and Prevention for 2009.

The table below lists the covered service detailing eligibility requirements and other useful billing information:

Service	Procedure Code(s)	Coverage	Frequency
Abdominal Aortic Aneurysm Screening	G0389-U/S exam AAA Screening	Any beneficiaries with certain risk factors and a referral resulting from an IPPE visit.	Once in a lifetime
Alcohol Misuse Screening and Counseling	G0442-Annual screening, 15 min. G0443-Brief face-to-face behavioral counseling for misuse, 15 min.	For screening: all beneficiaries. For misuse, furnished by PCP: all competent beneficiaries.	G0442-Once annually G0443-4 times per year
Annual Wellness Visit (AWV)	G0348-Initial Visit G0349-Subseqeunt Visit	Any beneficiary that has been effective for Part B for at least 1 year.	G0348- Once in a lifetime G0349- Once annually
Colorectal and Prostate Cancer Screenings	G0104-Flexible Sigmoidoscopy or G0106-Barium Enema G0105-Colonoscopy (high risk) or G0120-Barium Enema G0121-Colonoscopy (not high risk) G0328-Fecal Occult Blood Test immunoassay 82270- Fecal Occult Blood Test by peroxidase activity.	Any beneficiary aged 50 or over who are at normal or high risk for developing Colo-rectal cancer.	G0328/82270-Once annually G0104-Once every 4 years or 120 months after G0121 G0121-Once every 10 years or 48 months after G0104 or every 24 months for high risk G0106/G0120-Once every 48 months or 24 months for high risk.
Cardiovascular Disease Screenings	80061-Lipid Panel 82465-Cholesterol 83718-Lipoprotein 84478-Triglycerides	Any beneficiaries w/o signs or symptoms of cardiovascular disease	Every 5 years
Depression Screening	G0444-Annual screening, 15 min.	Any beneficiary as furnished by PCP with proper support staff.	Once annually
Diabetes Screening	82947-Blood Glucose; quantitative 82950-Glucose;post-glucose dose 82951-Glucose;3 specimen tolerance test	Any beneficiaries with risk factors or diagnoses with pre-diabetes.	Once annually if no pre-diabetes. Twice annually with pre-diabetes.
HIV Screening	G0432-Infectious agent by EIS technique G0433-Infectious agent by ELISA technique G0435-Infectious agent by rapid antibody test	Any beneficiaries at increased risk for HIV infection or pregnant.	Annually for high risk beneficiaries. Three times per pregnancy.
Immunizations (Seasonal Influenza, Pneumococcal, and Hepatitis B)	90654-90657, 90660-90662, Q2034-Q2039-Influenza Virus Vaccine/ G0008 administration 90669-90670,90732-Pneumococcal Vaccine/ G0009-Administration 90740,90743-90744, 90746-90747-Hepatitis B Vaccine/G0010 administration	Influenza and Pneumococcal: all beneficiaries. Hepatitis B:i any beneficiaries at intermediate or high risk for	Influenza- Once per season. Pneumococcal- Once in a lifetime. Hepatitis B- Scheduled dosages as required.
Intensive Behavioral Therapy for Cardiovascular Disease	G0446-IBT to reduce cardiovascular disease risk; individual, face-to-face, bi-annual, 15 min.	Furnished by PCP: Male beneficiaries aged 45-79-encouraging aspirin use, adults aged 18 or older- screening for hypertension, adults with risk factors- promoting a healthy diet	Once annually
Intensive Behavioral Therapy for Obesity	G0447-Behavioral counseling, face-to-face, 15 min.	Beneficiaries with BMI greater than or equal to 30 kg/m^2,furnished by PCP.	One visit per week in first month. One visit every 2 weeks, months 2-6. One visit per month, months 7-12.
Prostate Cancer Screening	G0102-Digital rectal exam G0103-Prostate Specific Antigen test	All male beneficiaries aged 50 and older.	Once annually
Tobacco Use Cessation Counseling	G0436-Counseling for the asymptomatic patient; intermediate >3min. up to 10 min. G043-Couseling for the asymptomatic patient; intensive, > 10 min.	All outpatient and inpatient beneficiaries.	Two cessation attempts per year: attempt = max of four sessions, up to eight sessions in 12 months.