Laboratory Question for the Week of March 6, 2017

Question:

How often can preventive screening tests be performed for Medicare patients?

Answer:

Typically, with few exceptions, Medicare-covered preventive screening tests are covered once per year. (Exceptions include two screen¬ing tests per year for beneficiaries diagnosed with prediabetes and cardiovascu¬lar screening tests, which are covered every five years.) Diagnostic procedures included in either local or national coverage determinations have varying frequency limitations depending on the test and the diagnosis. Tests, such as Hgb A1C, are paid once per quarter. Because the same procedure codes may be covered as either a preventive screening benefit or a diagnostic service benefit, it is absolutely essential that the CPT as well as diagnosis information accurately represent the test performed and the reason for the test.