New Medicare Preventive Services

Date Issued: 6/12/2015

The Centers for Medicare and Medicaid Services added a new behavioral health therapy method and two new screenings to cover preventive care services as of January 1, 2015. Digital Breast Tomosynthesis allows for three-dimensional imaging of tissue using X-Ray technology, which is less invasive or expensive than CAT scans. Tomosynthesis also affords better diagnostic detection. Also, Chest CAT (CT) scans are covered for Medicare members when a history of smoking or other environmental factors have been shown. In all three instances, member liability has been waived for these services:

  1. Intensive Behavioral Therapy for Obesity obesity in a group setting: G0473
    • Covered if billed with Dx diagnosis codes for Body Mass Index 30.0 and over.
      • ICD9: V85.30-V85.39, V85.41-V85.45
      • ICD10: Z68.30- Z68.39, Z68.41-Z68.45
    • When provided in the following locations of service:
      • Office (POS 11)
      • Outpatient Hospital (POS 22)
      • Independent clinic (POS 49)
      • Public health clinic (POS 71)
    • Maximum of 22 visits in a 12- month period (includes G0447 and G0473)
  2. Digital Breast Tomosynthesis: 77063
    • Covered if billed with CPT G0202 and diagnosisDx code:
      • ICD9: V76.11 or V76.12
      • ICD10: Z12.31
    • Facility claims pay on TOB 12X, 13X, 22X, 23X, or
    • OrR TOB 85X with revenue code other than 096x, 097x, 098x
  3. Chest CAT (CT) Scan, when billed as a preventive service for Medicare : 71250
    • Covered when billed with the following Dx codes:.
      • V15.82V15.82 Personal history of tobacco use, presenting hazards to health
      • V15.89V15.89 Other specified personal history presenting hazards to health
      • V62.1V62.1 Adverse effects of work environment
      • 305.1305.1 Nondependent tobacco use disorder
      • V70.0 Routine general medical examination at a health care facility