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Home > Medical Professionals > Practice Resources > Diversity Topics > Screening Medicare Benefit FAQs

AAA Screening Medicare Benefit FAQs

What is the new Medicare Benefit?

Medicare now offers a free, one-time, ultrasound screening benefit to check for Abdominal Aortic Aneurysm (AAA) in qualified seniors linked to their “Welcome to Medicare Physical Exam” which is formally called the “Initial Preventive Physical Exam”, or IPPE. This benefit became a law on February 8, 2006, as the Screening Abdominal Aortic Aneurysms Very Efficiently Act, a provision of S.1932, the Deficit Reduction Act of 2005.

How do I determine who qualifies for the screening?

Men who have smoked at least 100 cigarettes during their life, and men and women with a family history of AAA qualify for the one-time screening once they have undergone the IPPE. The IPPE must be completed within the first 12 months of Medicare eligibility, but there is no published time limit thereafter for completion of the AAA screening. Providers who perform the IPPE physical and order the AAA screening need to document the AAA risk factors.

Who orders the AAA screening ultrasound test?

The provider who performs the IPPE is the only person who can order the ultrasound test. The word "referral" in the proposed rule is taken directly from the federal legislation. Congressional intent differs from what the medical community typically considers a “referral.”  SVS has confirmed that the benefit does not imply a physician-to-physician clinical referral. In this setting the word “referral” means that the provider “orders” the ultrasound screening test.

What happens to the patient if there is a positive finding of AAA during the screening? 

The provider who orders the aortic ultrasound will receive the result and provide the findings to the patient. If the AAA is large, the patient would be best served by undergoing consultation with a vascular surgeon. If the AAA is small, the provider who ordered the ultrasound may elect to follow the patient, or a vascular surgery consultation may be requested.

How should we code the screening?

Ultrasound screening for AAA should be reported with code G0389 starting on January 1, 2007. 

What will be the rate of reimbursement?

In 2007, based on the published Medicare Physician Fee Schedule, the transitioned non-facility Technical Component RVUs for AAA screening code G0389 will total 1.66, and the transitioned work-adjusted Professional Component RVUs will total 0.74. With the 2007 Medicare Conversion Factor of $37.90, the technical payment will be $62.91, and the professional interpretation, $28.04. These values are national numbers, and actual payments will vary based on geographic practice cost indices.

If the technical component of this exam is performed in the hospital outpatient setting, the 2007 national technical payment has been posted as $95.93, and the professional interpretation fee will be taken from the Medicare Physicians Fee schedule, $28.04, subject to geographic practice cost index adjustment.  Note: These payment amounts were updated on January 24, 2007.