Wiki Abdominal Aortic Aneurysm Ultrasound in Office

[Kstover1026]

Hi everyone,

I have some questions about AAA ultrasounds done in the office. Our population is largely made up of patients with Medicare/Medicare Replacement plans. During the AAPC webinar about wellness visits, it was mentioned that the criteria for these scans were lifted or loosened at some point. All we have been able to find is that the patient must be 65 or over, male and a smoker. Has anyone found documentation from CMS about these requirements being lifted or loosened? Can these scans be done during a regular office visit, or can they only be done during the wellness visit? Any links to documents from CMS you may have would be greatly appreciated. Thank you!

 

[thomas7331]

The restrictions you're speaking of apply just to the AAA screening Medicare preventive care benefit - the specific CMS guidance on this can be found in Chapter 9 of the Medicare Claims Processing Manual, Section 110 (starts on page 173 here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf). I'm not aware that the restrictions for this benefit have been changed recently. However, these criteria apply only to the preventive care benefit for asymptomatic patients. A medically necessary diagnostic ultrasound would still be covered for symptomatic patients. You may wish to check the LCDs of your particular Medicare MAC for additional information. Also, the Medicare replacement plans you contract with may have additional benefits and/or payment policies that govern these procedures so you may wish to contact them for additional information or review the policies on their web sites. Hope this helps a little.