Medicare -- AAA Screening

[Guest guest]

If you really want to jump through some hoops...you can screen for AAA.

Buyt you have to do the referral as a result of the Medicare Physical, plus

the other guidelines below.

Locke, MD

http://www.aafp.org/fpm/20070400/letters.html

Welcome to Medicare visit and AAA screening

Kent 's article " <http://www.aafp.org/fpm/20070200/25what.html> What's

New in Medicare Preventive Benefits " [February 2007] explains that the

abdominal aortic aneurysm (AAA) screening benefit for patients age 65 to 75

who have smoked at least 100 cigarettes is available as part of the Welcome

to Medicare physical. Isn't it true that patients have only six months from

the time they get their Medicare card to have the Welcome to Medicare

physical? If so, then this benefit seems limited to those patients between

the ages of 65 and 65½. Even then, the screening is available only if we see

the patient for a Welcome to Medicare physical and order it at that time. Is

this benefit not available for patients who are older than 65½? Is it really

only available at the time we see a patient for a Welcome to Medicare

physical? I find it limiting and contradictory that Medicare would not

provide coverage for AAA screenings for the many people who fall into the

high-risk categories listed in the article but never had or wanted the

Welcome to Medicare visit.

Wells, MD

Asheville, N.C.

Author's response:

Medicare coverage of AAA screenings is effective for services furnished on

or after Jan. 1, 2007, for qualified beneficiaries who meet the following

criteria:

1. They receive a referral for an ultrasound screening as a result of an

initial preventive physical exam [also known as the Welcome to Medicare

physical].

2. They receive an ultrasound screening from a provider or supplier who is

authorized to provide covered diagnostic services.

3. They have not been previously furnished an ultrasound screening under the

Medicare program.

4. They are included in at least one of the following risk categories:

* Those with a family history of AAA;

* Men age 65 to 75 who have smoked at least 100 cigarettes in their

lifetime;

* Beneficiaries who manifest other risk factors in a beneficiary category

recommended for AAA screening by the United States Preventive Services Task

Force.

So you are correct, in a sense, that only Medicare beneficiaries who have

had a Welcome to Medicare physical and received a referral for the AAA

screening as a result of that exam are eligible for the AAA screening (as

long as they also meet the other coverage criteria). The rules do not say

that the AAA screening must occur in the same time period as the Welcome to

Medicare physical, so, theoretically, the AAA screening could be covered

after a beneficiary's first six months of eligibility, as long as the

screening resulted from a referral at the Welcome to Medicare physical.

I understand your feeling that this policy is overly restrictive.

Unfortunately, in this case Medicare policy is dictated by the law that

created the benefit (section 5112 of the Deficit Reduction Act of 2005). As

such, it would require an act of Congress to change it. I encourage you to

share your perspective with your Congressional representatives, which you

can do through " Speak Out, " the AAFP's Legislative Action Center, online at

<http://capitol.aafp.org/> http://capitol.aafp.org/.