**B. Nationally Covered Indications**

Effective for claims with dates of service on or after November 8, 2011, CMS
covers intensive behavioral therapy for CVD (referred to below as a CVD risk
reduction visit), which consists of the following three components:

  * encouraging aspirin use for the primary prevention of CVD when the benefits outweigh the risks for men age 45-79 years and women 55-79 years;
  * screening for high blood pressure in adults age 18 years and older; and
  * intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular- and diet-related chronic disease.

We note that only a small proportion (about 4%) of the Medicare population is
under 45 years (men) or 55 years (women), therefore the vast majority of
beneficiaries should receive all three components. Intensive behavioral
counseling to promote a healthy diet is broadly recommended to cover close to
100% of the population due to the prevalence of known risk factors.

Therefore, CMS covers one, face-to-face CVD risk reduction visit per year for
Medicare beneficiaries who are competent and alert at the time that counseling
is provided, and whose counseling is furnished by a qualified primary care
physician or other primary care practitioner in a primary care setting.

The behavioral counseling intervention for aspirin use and healthy diet should
be consistent with the Five As approach that has been adopted by the USPSTF to
describe such services:

  * **Assess:** Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  * **Advise:** Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  * **Agree:** Collaboratively select appropriate treatment goals and methods based on the patients interest in and willingness to change the behavior.
  * **Assist:** Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  * **Arrange:** Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

For the purpose of this NCD, a primary care setting is defined as the
provision of integrated, accessible health care services by clinicians who are
accountable for addressing a large majority of personal health care needs,
developing a sustained partnership with patients, and practicing in the
context of family and community. Emergency departments, inpatient hospital
settings, ambulatory surgical centers, independent diagnostic testing
facilities, skilled nursing facilities, inpatient rehabilitation facilities,
and hospices are not considered primary care settings under this definition.

For the purpose of this NCD, a primary care physician and primary care
practitioner are defined consistent with existing sections of the Act
(1833(u)(6), 1833(x)(2)(A)(i)(I) and 1833(x)(2)(A)(i)(II)).

1833(u)  
(6) Physician Defined.For purposes of this paragraph, the term physician
means a physician described in section 1861(r)(1) and the term primary care
physician means a physician who is identified in the available data as a
general practitioner, family practice practitioner, general internist, or
obstetrician or gynecologist.

1833(x)(2)  
(A) Primary care practitioner.The term primary care practitioner means an
individual  
(i) who  
(I) is a physician (as described in section 1861(r)(1)) who has a primary
specialty designation of family medicine, internal medicine, geriatric
medicine, or pediatric medicine; or  
(II) is a nurse practitioner, clinical nurse specialist, or physician
assistant (as those terms are defined in section 1861(aa)(5)).

**C. Nationally Non-Covered Indications**

Unless specifically covered in this NCD, any other NCD, or in statute,
preventive services are non-covered by Medicare.

**D. Other**

Medicare coinsurance and Part B deductible are waived for this preventive
service.

(This NCD last reviewed November 2011.)