# Labs for Medicare Wellness Exams



## lisa dixon

How far in advance to a patient being seen for the Medicare Wellness Exam can he/she have the labs and EKG performed?

Thanks,
Lisa D


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## Stefanie

Depends on if you are looking to have any of these services covered by Medicare.

An EKG is only covered once-in-a-lifetime for wellness purposes when ordered or performed as a result of an IPPE (a/k/a "Welcome to Medicare" visit).  Therefore I have always told providers it can be during or after the IPPE.

As far as wellness labs, there are only a few that are truly "wellness"; 
1.  Cardiovascular screening (80061-Lipid Panel, 82465 - Cholesterol, 83718 - Lipoprotein, 84478 - Triglycerides, reported with one or more of the following ICD-9, V81.0, V81.1, V81.2) - allowed every 5 years as along as the Medicare patient is without apparent signs or symptoms of CV Dz.  No restriction on when they have to be ordered or performed other then the frequency limitation.

2.  Diabetes Screenings - (82947 - Glucose, quantitative, blood (except reagent strip), 82950 - Glucose; post-glucose dose (incluides glucose), 82951 - Glucose; tolerance tests (GTT), 3 spec. (incld. glucose).  2 screening tests per year for beneficiaries diagnosed with pre-diabetes, 1 screeing per year if previously tests, but not diagnosed with pre-diabetes or if never tested. Patient's diagnosed with diabetes are NOT eligible for this benefit; no restriction on when they have to be ordered or performed other then the frequency limitation. 

3.  PSA (G0103 - V76.44) for all male Medicare patient's aged 50 and older covered annually, no restriction on when they have to be ordered or performed other then the frequency limitation. 

Below is a great Quick Reference on Preventive Services that MLN has provider:
http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/downloads/MPS_QuickReferenceChart_1.pdf

Hope this helps.


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## Stefanie

P.S.  Any other labs ordered or performed as wellness and don't fall into the above limitations criteria, will be considered patient responsibility and it doesn't matter when you order or perform them.


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