(Medicare Claims Processing Manual)

220.5 -  Common Working File (CWF) Edits   230  Screening for Hepatitis B Virus (HBV)   230.1  Institutional Billing Requirements   230.2  Professional Billing Requirements   230.3  Diagnosis Code Reporting Requirements  230.4  Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages  240 -  Prolonged Preventive Services Codes      1.2  Table of Preventive and Screening Services  (Rev. 12299; Issued:10 -12-23; Effective:01 -01-23; Implementation:11 -13-23)   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible   Initial Preventive Physical Examination, IPPE   G0402  Initial  preventive  physical examination; face to face visits, services limited to new beneficiary  during the first 12 months of Medicare enrollment   *Not Rated   WAIVED   G0403  Electrocardiogram,  routine ECG with 12 leads; performed as a screening for the initial preventive physical examination  with interpretation and report   Not Waived   G0404  Electrocardiogram, routine ECG with 12 leads; tracing only,  without  interpretation and report, performed as a screening for the initial preventive physical examination   Not Waived   G0405  Electrocardiogram,  routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination   Not Waived   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    Ultrasound Screening  for Abdominal Aortic Aneurysm (AAA)  services furnished prior to January  1, 2017   G0389  Ultrasound, B -scan and /or real time with image documentation; for abdominal  aortic  aneurysm (AAA) ultrasound screening   B  WAIVED  Ultrasound Screening  for Abdominal Aortic Aneurysm (AAA)  services furnished  on or after January 1,  2017   76706  Ultrasound,  abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)   B  WAIVED  Cardiovascular Disease Screening   80061   Lipid  panel   A  WAIVED   82465  Cholesterol,  serum  or whole blood, total   WAIVED   83718  Lipoprotein, direct measurement; high density  cholesterol  (hdl cholesterol)   WAIVED  84478  Triglycerides  WAIVED   Diabetes Screening Tests   82947  Glucose; quantitative, blood (except reagent strip)   B  WAIVED   82950  Glucose; post glucose dose (includes  glucose)   WAIVED   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    82951  Glucose;  tolerance test (gtt), three specimens (includes glucose)   *Not Rated   WAIVED     Diabetes  Self- Management Training Services (DSMT)   G0108  Diabetes  outpatient  self- management training services,  individual, per 30 minutes   *Not Rated   Not Waived   G0109  Diabetes outpatient self - management training services,  group session  (2 or more), per  30 minutes   Not Waived   Medical Nutrition Therapy (MNT)  Services   97802  Medical nutrition therapy; initial assessment and intervention,  individual, face-to-face with the patient,  each 15 minutes   B  WAIVED   97803  Medical  nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes   WAIVED   97804  Medical  nutrition therapy; group (2 or more individual(s)), each 30 minutes   WAIVED      Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    G0270  Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis,  medical  condition or treatment regimen (including additional hours needed for renal disease), individual,  face to  face with the patient,  each 15 minutes            B  WAIVED    G0271  Medical nutrition therapy, reassessment  and subsequent intervention(s) following second  referral  in same  year for change in diagnosis, medical condition, or treatment  regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes    WAIVED   Screening  Pap Test  G0123  Screening cytopathology, cervical or vaginal (any reporting  system),  collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision          A  WAIVED   G0124  Screening cytopathology, cervical or vaginal (any reporting  system),  collected in preservative fluid, automated thin layer preparation, requiring interpretation  by physician  WAIVED   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    G0141  Screening cytopathology smears,  cervical  or vaginal, performed by automated system, with manual rescreening, requiring interpretation  by physician  A  WAIVED    G0143  Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid,  automated  thin layer preparation, with manual screening  and rescreening by cytotechnologist  under physician supervision   A  WAIVED   G0144  Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation,  with screening by automated system, under physician supervision   A  WAIVED   G0145  Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation,  with screening by automated system and manual rescreening under physician supervision   A  WAIVED   G0147  Screening  cytopathology smears, cervical or vaginal, performed by automated system under physician supervision   A  WAIVED   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    G0148  Screening  cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening   A  WAIVED    P3000 Screening papanicolaou smear,  cervical  or vaginal, up to three smears, by technician  under  physician supervision    WAIVED    P3001 Screening  papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician    WAIVED   Q0091  Screening papanicolaou smear;  obtaining, preparing and conveyance of cervical or vaginal smear to laboratory   WAIVED   Screening Pelvic  Exam   G0101  Cervical  or vaginal  cancer screening; pelvic and clinical  breast  examination  A  WAIVED   Screening Mammography   77052  Computer -aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code  for primary procedure)   B  WAIVED   77057  Screening mammography, bilateral  (2-view  film study of each breast)   B  WAIVED   Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible    77063  Screening  digital breast tomosynthesis,  bilateral    WAIVED   77067  Screening mammography, bilateral  (2-view  study of each breast), including computer - aided  detection  (CAD) when performed   WAIVED   Bone Mass Measurement   G0130  Single energy x -ray absorptiometry (sexa) bone density study, one or more sites;  appendicular  skeleton (peripheral) (e.g., radius, wrist, heel)   B  WAIVED   77078  Computed tomography, bone mineral density study, 1 or more sites; axial  skeleton  (e.g., hips, pelvis, spine)   WAIVED     77079  Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral)  (e.g.,  radius, wrist, heel)     WAIVED   77080  Dual -energy x- ray absorptiometry (dxa), bone density study, 1 or more  sites;  axial  skeleton (e.g.,  hips, pelvis, spine)   WAIVED   77081  Dual -energy x- ray absorptiometry  (dxa),  bone density study, 1 or more sites;  appendicular  skeleton (peripheral) (e.g., radius, wrist, heel)   WAIVED    Service  CPT/ HCPCS   Long  Descriptor  USPSTF  Rating  Coins./ Deductible         77085  Dual -energy X -ray absorptiometry (DXA), bone density study,  1 or more  sites, axial skeleton, (e.g., hips, pelvis, spine), including vertebral fracture assessment.    WAIVED    76977  Ultrasound  bone  density measurement and interpretation,  peripheral site(s), any method    WAIVED  NOTE:  Anesthesia services furnished in conjunction with and in support of a screening colonoscopy  are reported  with  CPT code  00812 and coinsurance  and deductible  are waived.  When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 and with the PT modifier; only the deductible is waived.  Coinsurance  and deductible  are waived  for moderate sedation  services  (reported with G0500 or 99153) when furnished in conjunction with and in support of a screening colonoscopy service and when reported with modifier 33.  When a screening colonoscopy becomes a diagnostic colonoscopy, moderate sedation services (G0500 or 99153) are reported with only the PT modifier; only the deductible is waived.  For dates of service  in calendar year (CY) 2023 through CY 2026, when the  PT modifier is appended to at least one code on the claim to indicate that a screening colorectal cancer procedure, HCPCS G0104, G0105, or G0121, has become a diagnostic or therapeutic service, contractors shall continue to waive deductible, and shall appl y a reduced coinsurance of 15% for all procedure codes that meet the requirements stated above and are performed on that date of service and billed on the same claim.  For dates of service in CY 2027 through CY 2029, contractors shall continue to waive deductible and shall apply a reduced coinsurance of 10% for  all procedure  codes  that meet  the requirements  stated  above  and are performed on that date of service and billed on the same claim.  For dates of service on or after January 1, 2030, contractors shall continue to waive deductible and shall waive  coinsurance  for all procedure  codes  that meet  the requirements  stated  above and are performed on that date of service and billed on the same claim.   Colorectal Cancer Screening   G0104  Colorectal cancer screening;  flexible sigmoidoscopy   A   WAIVED