(Medicare National Coverage Determinations Manual)

2. Brief face -to-face behavioral counseling interventions are non- covered when performed more than once a day; that is, two counseling interventions on the same day are non- covered.   3. Brief face -to-face behavioral counseling interventions are non- covered when performed more than four times in a 12- month period  D. Other  Medicare coinsurance and Part B deductible are waived for this preventive service   (This NCD last reviewed October 2011.)   210.9  Screening for Depression in Adults (Effective October 14, 2011)  (Rev. 139, Issued: 11- 23-11, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A. General   Among persons older than 65 years, one in six suffers from depression.  Depression in older adults is estimated to occur in 25% of those with other illness including cancer, arthritis, stroke, chronic lung disease, and cardiovascular disease.  Other stress ful events, such as the loss of friends and loved ones, are also risk factors for depression.  Opportunities are missed to improve health outcomes when mental illness is under -recognized and under -treated in primary care settings.   Older adults have the highest risk of suicide of all age groups.  These patients are important in the primary care setting because 50 -75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% w ere seen during the week prior to their death. Symptoms of major depression that are felt nearly every day include, but are limited to, feeling sad or empty; less interest in daily activities; weight loss or gain when not dieting; less ability to think or concentrate; tearfulness, feelings of worthlessness, and thoughts of death or suicide.   Based upon authority to cover additional preventive services for Medicare beneficiaries if certain statutory requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national coverage analysis on screening for depression i n adults.  Screening for depression in adults is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF) and is appropriate for individuals entitled to benefits under Part A and Part B.   Therefore, effective October 14, 2011, CMS will cover annual screening for depression for Medicare beneficiaries in primary care settings that have staff -assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow -up.  Various screening tools are available for screening for depression.  CMS does not identify specific depression screening tools.  Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting.   Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combinat ion therapy (counseling and medications), or other interventions for depression.   B. Nationally Covered Indications   Effective for claims with dates of service on or after October 14, 2011, CMS will cover annual screening up to 15 minutes for Medicare beneficiaries when staff -assisted depression care supports are in place to assure accurate diagnosis, effective treatment , and follow -up.  At a minimum level, staff -assisted supports consist of clinical staff (e.g., nurse, physician assistant) in the primary care setting who can advise the physician of screening results and who can facilitate and coordinate referrals to ment al health treatment.   C. Nationally Non -Covered Indications   Screening for depression is non- covered when performed more than one time in a 12- month period. In addition, self -help materials, telephone calls, and web -based counseling are not separately reimbursable by Medicare and are not part of this NCD.  D. Other  Medicare coinsurance and Part B deductible are waived for this preventive service   (This NCD last reviewed October 2011.)   210.10 - Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs  (Rev. 141, Issued: 01- 26-12, Effective: 11 -08-2011, Implementation: 02- 27-12)  A. General   Sexually transmitted infections (STIs) are infections that are passed from one person to another through sexual contact.  STIs remain an important cause of morbidity in the United States and have both health and economic consequences.  Many of the complications of STIs are borne by women and children  Often, STIs do not pres ent any symptoms so can go untreated for long periods of time  The presence of an STI during pregnancy may result in significant health complications for the woman and infant.  In fact, any person who has an STI may develop health complications.  Screening  tests for the STIs in this national coverage determination (NCD) are laboratory tests.   Under 1861(ddd) of the Social Security Act (the Act), the Centers for Medicare & Medicaid Services (CMS) has the authority to add coverage of additional preventive services if certain statutory requirements are met.  The regulations provide:   410.64 Additional preventive services   (a) Medicare Part B pays for additional preventive services not described in paragraph (1) or (3) of the definition of preventive services under 410.2, that identify medical conditions or risk factors for individuals if the Secretary determines through the national coverage determination process (as defined in section 1869(f)(1)(B) of the Act) that these services are all of the following: (1) reasonable and necessary for the prevention or early detection of illness or disability.(2) recommended with a grade of A or B by the United States Preventive Services Task Force, (3) appropriate for individuals entitled to benefits under Pa rt A or enrolled under Part B.  (b) In making determinations under paragraph (a) of this section regarding the coverage of a new preventive service, the Secretary may conduct an assessment of the relation between predicted outcomes and the expenditures for such services and may take into account the results of such an assessment in making such national coverage determinations.  The scope of the national coverage analysis for this NCD evaluated the evidence for the following STIs and high intensity behavioral counseling (HIBC) to prevent STIs for which the United States Preventive Services Task Force (USPSTF) has issued either an A or B recommendation:    Screening for chlamydial infection for all sexually active non- pregnant young women aged 24 and younger and for older non- pregnant women who are at increased risk,   Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk,    Screening for gonorrhea infection in all sexually active women, including those who are pregnant, if they are at increased risk,    Screening for syphilis infection for all pregnant women and for all persons at increased risk,    Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit,    HIBC for the prevention of STIs for all sexually active adolescents, and for adults at increased risk for STIs.   B. Nationally Covered Indications   CMS has determined that the evidence is adequate to conclude that screening for chlamydia, gonorrhea, syphilis, and hepatitis B, as well as HIBC to prevent STIs, consistent with the grade A and B recommendations by the USPSTF, is reasonable and necessary f or the early detection or prevention of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.  Therefore, effective for claims with dates of services on or after November 8, 2011, CMS will cover screening for these USPSTF -indicated STIs with the appropriate Food and Drug Administration (FDA) -approved/cleared laboratory tests, used consistent with FD A-approved labeling, and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the primary care physician or practitioner, and performed by an eligible Medicare provider for these services.   Screening for chlamydia and gonorrhea:    Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high- risk sexual behavior has occurred since the initial screening test.    Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high- risk sexual behavior has occurred since the initial screening test.    Women at increased risk for STIs annually.   Screening for syphilis:    Pregnant women when the diagnosis of pregnancy is known, and then repeat screening during the third trimester and at delivery if high- risk sexual behavior has occurred since the previous screening test.   Men and women at increased risk for STIs annually.  Screening for hepatitis B:    Pregnant women at the first prenatal visit when the diagnosis of pregnancy is known, and then rescreening at time of delivery for those with new or continuing risk factors.   In addition, effective for claims with dates of service on or after November 8, 2011, CMS will cover up to two individual 20-  to 30- minute, face -to-face counseling sessions annually for Medicare beneficiaries for HIBC to prevent STIs, for all sexually acti ve adolescents, and for adults at increased risk for STIs, if referred for this service by a primary care physician or practitioner, and provided by a Medicare eligible primary care provider in a primary care setting.  Coverage of HIBC to prevent STIs is c onsistent with the USPSTF recommendation.  HIBC is defined as a program intended to promote sexual risk reduction or risk avoidance, which includes each of these broad topics, allowing flexibility for appropriate patient -focused elements:    education,   skills training,   guidance on how to change sexual behavior.   The high/increased risk  individual sexual behaviors, based on the USPSTF guidelines, include any of the following:    Multiple sex partners   Using barrier protection inconsistently  Having sex under the influence of alcohol or drugs   Having sex in exchange for money or drugs   Age (24 years of age or younger and sexually active for women for chlamydia and gonorrhea)   Having an STI within the past year   IV drug use (for hepatitis B only)   In addition for men  men having sex with men (MSM) and engaged in high risk sexual behavior, but no regard to age   In addition to individual risk factors, in concurrence with the USPSTF recommendations, community social factors such as high prevalence of STIs in the community populations should be considered in determining high/increased risk for chlamydia, gonorrhea, syphilis, and for recommending HIBC.   High/increased risk sexual behavior for STIs is determined by the primary care provider by assessing the patients sexual history which is part of any complete medical history, typically part of an annual wellness visit or prenatal visit and considered in the development of a comprehensive prevention plan. The medical record should be a reflection of the service provided.  For the purposes 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, clinics providing a limited focus of health care services, and hospice are examples of settings not considered primary care settings under this definition.  For the purposes of this NCD, a  primary care physician  and primary care practitioner  will be defined based on existing sections of the Social Security 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)(i)  (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 these preventive services.