Showing posts with label Medicare covered services. Show all posts
Showing posts with label Medicare covered services. Show all posts

Tuesday, August 14, 2012

when Medicare covers BMM service

Definition


BMM means a radiologic, radioisotopic, or other procedure that meets all of the following conditions:

• Is performed to identify bone mass, detect bone loss, or determine bone quality.
• Is performed with either a bone densitometer (other than single-photon or dual-photon absorptiometry) or a bone sonometer system that has been cleared for marketing for BMM by the Food and Drug Administration (FDA) under 21 CFR part 807, or approved for marketing under 21 CFR part 814.
• Includes a physician’s interpretation of the results.


Conditions for Coverage


Medicare covers BMM under the following conditions:
1. Is ordered by the physician or qualified nonphysician practitioner who is treating the beneficiary following an evaluation of the need for a BMM and determination of the appropriate BMM to be used.
A physician or qualified nonphysician practitioner treating the beneficiary for purposes of this provision is one who furnishes a consultation or treats a beneficiary for a specific medical problem, and who uses the results in the management of the patient. For the purposes of the BMM benefit, qualified nonphysician practitioners include physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives.
2. Is performed under the appropriate level of physician supervision as defined in 42 CFR 410.32(b).
3. Is reasonable and necessary for diagnosing and treating the condition of a beneficiary who meets the conditions described in §80.5.6.
4. In the case of an individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy, is performed with a dual-energy x-ray absorptiometry system (axial skeleton).


5. In the case of any individual who meets the conditions of 80.5.6 and who has a confirmatory BMM, is performed by a dual-energy x-ray absorptiometry system (axial skeleton) if the initial BMM was not performed by a dual-energy x-ray absorptiometry system (axial skeleton). A confirmatory baseline BMM is not covered
if the initial BMM was performed by a dual-energy x-ray absorptiometry system (axial skeleton).


Frequency Standards


Medicare pays for a screening BMM once every 2 years (at least 23 months have passed since the month the last covered BMM was performed).
When medically necessary, Medicare may pay for more frequent BMMs. Examples include, but are not limited to, the following medical circumstances:
• Monitoring beneficiaries on long-term glucocorticoid (steroid) therapy of more than 3 months.
• Confirming baseline BMMs to permit monitoring of beneficiaries in the future.



Tuesday, September 29, 2009

Medicare part B covered services - CPTs

Medicare Part B Covered Preventive Services


•Bone Mass Measurement for certain people who are at risk of losing bone mass
•Colorectal Cancer Screening
1.Fecal Occult Blood Test once every 12 months
2.Flexible Sigmoidoscopy once every 48 months
3.Colonoscopy once every 24 months for people at high risk for colon cancer
4.Barium Enema (physician can subtitute for sigmoidoscopy or colonoscopy
•Diabetes Services for people who have diabetes (insulin users and non-users)
1 Coverage for glucose monitors, test strips, and lancets (coverage through DMERC)
2.Diabetes self-management training
•Mammography Screening for all women over age 40, once every 12 months
•Pap Smear and Pelvic Examination for all women, once every 36 months (beginning July 1, 2001, once every 24 months) and for women with high risk for cervical cancer or previous abnormal Pap Smear , once every 12 months
•Prostate Cancer Screening for men aged 50 and over;
1.Digital Rectal Examination every 12 months
2.Prostate Specific Antigen (PSA) Test once every 12 months
•Medical Nutrition Therapy (MNT) is a covered benefit effective January 1, 2002, for patients with diabetes or renal disease.
•Glaucoma Screening is a covered benefit effective January 1, 2002, for individuals with diabetes, a family history of glaucoma, or others determined to be at "high risk" for glaucoma.
•Vaccinations
1.Flu vaccination once a year in the fall and winter
2.Pneumonia vaccination (one lifetime)
3.Hepatitis B vaccination for people with medium to high risk for hepatitis

Non-Covered Services


•Routine physical examinations and tests directly related to such examinations
•Most routine foot care and dental care
•Examinations for prescribing or fitting eyeglasses or hearing aids
•Immunizations (except pneumococcal vaccinations, influenza vaccinations, hepatitis B for certain persons at risk or immunizations required because of an injury or immediate risk or infection)
•Cosmetic surgery, unless it is needed because of accidental injury or to improve the function of a malformed part of the body
•Services related to cosmetic surgery

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