Medicare now covers heart disease screening

The program adds the intensive therapy service to its list of preventive care that carries no additional out-of-pocket costs.

By CHARLES FIEGL, amednews staff. Posted Nov. 23, 2011.

Washington — The Medicare program has expanded its coverage policy manual to include annual visits that screen for hypertension and prevent cardiovascular disease.

The Centers for Medicare & Medicaid Services will cover office visits with primary care physicians to discuss how to prevent heart disease, the agency announced Nov. 8. The new exam will join a list of preventive services covered by the Medicare program at no additional out-of-pocket cost to the beneficiary.

“Access to preventive services helps Medicare beneficiaries identify health risk factors and disease early to provide greater opportunities for early treatment,” said CMS Administrator Donald M. Berwick, MD.

The new service aims to prevent hypertension, coronary heart disease, heart failure and stroke. The Medicare agency outlined three elements for intensive behavioral therapy for cardiovascular disease risk in a national coverage decision memo (www.cms.gov/medicare-coverage-database/details/nca-
decision-memo.aspx?NCAId=248
).

The components are:

  • Encouraging aspirin use for the primary prevention of cardiovascular disease when benefits outweigh risks for men ages 45 to 79 and women 55 to 79.
  • Screening for high blood pressure in adults over age 18.
  • Counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advanced age, and other known risk factors for cardiovascular and diet-related chronic disease.

The service can be provided by primary care physicians, such as family physicians or internists, or nurse practitioners in an office setting. CMS has created a temporary code, G0446, to bill the service. It would pay about $20 to $25, according to 2012 physician fee schedule data posted on the CMS website.

The new service does not change coverage for patients diagnosed with cardiovascular disease who are receiving assessment and intervention services, CMS said. In March, the American College of Cardiology had commended CMS for using its authority to expand coverage of preventive services, then-ACC president Ralph Brindis, MD, wrote in a letter to the agency. Read More