Table of Preventive and Screening Services (Rev. 3232, 01-05-15)

by  Jared Staheli
June 25th, 2015

Service CPT/HCPCS Code Long Descriptor USPSTF Rating Coins./ Deductible
Initial Preventive Physical Examination, IPPE G0402 Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment *Not Rated WAIVED
Initial Preventive Physical Examination, IPPE G0403 Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report *Not Rated Not Waived
Initial Preventive Physical Examination, IPPE G0404 Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination *Not Rated Not Waived
Initial Preventive Physical Examination, IPPE G0405 Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination *Not Rated Not Waived
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) G0389 Ultrasound, B-scan and /or real time with image documentation; for abdominal aortic aneurysm (AAA) ultrasound screening B WAIVED
Cardiovascular Disease 80061 Lipid panel A WAIVED
Cardiovascular Disease 82465 Cholesterol, serum or whole blood, total A WAIVED
Cardiovascular Disease 83718 Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol) A WAIVED
Cardiovascular Disease 84478 Triglycerides A WAIVED
Diabetes Screening Tests 82947 Glucose; quantitative, blood (except reagent strip) B WAIVED
Diabetes Screening Tests 82950 Glucose; post glucose dose (includes glucose) B WAIVED
Diabetes Screening Tests 82951 Glucose; tolerance test (gtt), three specimens (includes glucose) *Not Rated
WAIVED
Diabetes Self-Management Training Services (DSMT) G0108 Diabetes outpatient selfmanagement training services, individual, per 30 minutes *Not Rated Not Waived
Diabetes Self-Management Training Services (DSMT) G0109 Diabetes outpatient selfmanagement training services, group session (2 or more), per 30 minutes *Not Rated Not Waived
Medical Nutrition Therapy (MNT) Services 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes B WAIVED
Medical Nutrition Therapy (MNT) Services 97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes B WAIVED
Medical Nutrition Therapy (MNT) Services 97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes B WAIVED
Medical Nutrition Therapy (MNT) Services G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes B WAIVED
Medical Nutrition Therapy (MNT) Services G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes B WAIVED
Screening Pap Test G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision A WAIVED
Screening Pap Test G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician A WAIVED
Screening Pap Test G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician A WAIVED
Screening Pap Test G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision A WAIVED
Screening Pap Test G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision A WAIVED
Screening Pap Test G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision A WAIVED
Screening Pap Test G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision A WAIVED
Screening Pap Test G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening A WAIVED
Screening Pap Test P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision A WAIVED
Screening Pap Test P3001 Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician A WAIVED
Screening Pap Test Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory A WAIVED
Screening Pelvic Exam G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination A WAIVED
Screening Mammography 77052 Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) B WAIVED
Screening Mammography 77057 Screening mammography, bilateral (2-view film study of each breast) B WAIVED
Screening Mammography 77063 Screening digital breast tomosynthesis, bilateral B WAIVED
Screening Mammography G0202 Screening mammography, producing direct 2-D digital image, bilateral, all views B WAIVED
Bone Mass Measurement G0130 Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) B WAIVED
Bone Mass Measurement 77078 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) B WAIVED
Bone Mass Measurement 77079 Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) B WAIVED
Bone Mass Measurement 77080 Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) B WAIVED
Bone Mass Measurement 77081 Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) B WAIVED
Bone Mass Measurement 77083 Radiographic absorptiometry (e.g., photo densitometry, radiogrammetry), 1 or more sites B WAIVED
Bone Mass Measurement 76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method B WAIVED

NOTE: For Colorectal Cancer Screening, effective January 1, 2015, when anesthesia service 00810 is performed in conjunction with screening colonoscopy services G0105 or G0121, coinsurance and deductible will be waived for anesthesia service 00810 when modifier 33 is entered on the anesthesia claim. When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia code 00810 should be submitted with only the PT modifier and only the deductible will be waived.

Service CPT/ HCPCS Code Long Descriptor USPSTF Rating Coins./ Deductible
Colorectal Cancer Screening G0104 Colorectal cancer screening; flexible sigmoidoscopy A WAIVED
Colorectal Cancer Screening G0105 Colorectal cancer screening; colonoscopy on individual at high risk A WAIVED
Colorectal Cancer Screening G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema *Not Rated Coins. Applies & Ded. is waived
Colorectal Cancer Screening G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema. *Not Rated Coins. Applies & Ded. is waived
Colorectal Cancer Screening G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk A WAIVED
Colorectal Cancer Screening 82270 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive A WAIVED
Colorectal Cancer Screening G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous A WAIVED
Prostate Cancer Screening G0102 Prostate cancer screening; digital rectal examination D Not Waived
Prostate Cancer Screening G0103 Prostate cancer screening; prostate specific antigen test (PSA) D WAIVED
Glaucoma Screening G0117 Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist I Not Waived
Glaucoma Screening G0118 Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist I Not Waived
Influenza Virus Vaccine 90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use B WAIVED
Influenza Virus Vaccine 90654 Influenza virus vaccine, split virus, preservative free, for intradermal use, for adults ages 18-64 B WAIVED
Influenza Virus Vaccine 90655 Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use B WAIVED
Influenza Virus Vaccine 90656 Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use B WAIVED
Influenza Virus Vaccine 90657 Influenza virus vaccine, split virus, when administered to children 6- 35 months of age, for intramuscular use B WAIVED
Influenza Virus Vaccine 90660 Influenza virus vaccine, live, for intranasal use B WAIVED
Influenza Virus Vaccine 90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use B WAIVED
Influenza Virus Vaccine 90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use B WAIVED
Influenza Virus Vaccine 90672 Influenza virus vaccine, live, quadrivalent, for intranasal use B WAIVED
Influenza Virus Vaccine 90673 Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use B WAIVED
Influenza Virus Vaccine 90685 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6- 35 months of age, for intramuscular use B WAIVED
Influenza Virus Vaccine 90686 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use B WAIVED
Influenza Virus Vaccine 90687 Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use B WAIVED
Influenza Virus Vaccine 90688 Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use B WAIVED
Influenza Virus Vaccine G0008 Administration of influenza virus vaccine B WAIVED
Pneumococcal Vaccine 90669 Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use B WAIVED
Pneumococcal Vaccine 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use. B WAIVED
Pneumococcal Vaccine 90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use B WAIVED
Pneumococcal Vaccine G0009 Administration of pneumococcal vaccine B WAIVED
Hepatitis B Vaccine 90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use A WAIVED
Hepatitis B Vaccine 90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use A WAIVED
Hepatitis B Vaccine 90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use A WAIVED
Hepatitis B Vaccine 90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use A WAIVED
Hepatitis B Vaccine 90746 Hepatitis B vaccine, adult dosage, for intramuscular use A WAIVED
Hepatitis B Vaccine 90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use A WAIVED
Hepatitis B Vaccine G0010 Administration of Hepatitis B vaccine A WAIVED
Hepatitis C Virus Screening G0472 Screening for Hepatitis C antibody B WAIVED
HIV Screening G0432 Infectious agent antigen detection by enzyme immunoassay (EIA) technique, qualitative or semi-qualitative, multiplestep method, HIV-1 or HIV-2, screening A WAIVED
HIV Screening G0433 Infectious agent antigen detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody, HIV-1 or HIV-2, screening A WAIVED
HIV Screening G0435 Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV- 2 , screening A WAIVED
Smoking Cessation G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes A WAIVED
Smoking Cessation G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient intensive, greater than 10 minutes A WAIVED
Annual Wellness Visit G0438 Annual wellness visit, including PPPS, first visit *Not Rated WAIVED
Annual Wellness Visit G0439 Annual wellness visit, including PPPS, subsequent visit *Not Rated WAIVED
Intensive Behavioral Therapy for Obesity G0447 Face-to-Face Behavioral Counseling for Obesity, 15 minutes B WAIVED
Intensive Behavioral Therapy for Obesity G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minute(s) B WAIVED

References:

Table of Preventive and Screening Services (Rev. 3232, 01-05-15). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/table-of-preventive-and-screening-services-rev-3232-01-05-15-26889.html

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