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Medicare Payments for Screening Tests

Welcome to Medicare Exam
Patients are entitled one ?Welcome to Medicare? physical exam in their first 6 months of Medicare enrollment. The exam includes several preventive services including diabetes and cardiovascular disease screenings, prostate cancer screening and an ECG. Laboratory and ECG tests are billed separately from the exam.

  • G0344 Welcome to Medicare Exam $97.40
  • Cardiovascular Screening Benefit: Once every 5 years
    Tests may be ordered individually or together as a lipid panel:

    • 82465 Cholesterol, serum or whole blood, total. $6.08
    • 83718 HDL. $11.44
    • 84478 Triglycerides. $8.04
    • 80061 Lipid panel. $18.72 (Total cholesterol, HDL and Trig.)
    Use V81.0 (screen for ischemic heart disease), V81.1 (screen for hypertension) or V81.2 (screen, other cardiovascular conditions)

    Diabetes screening: Up to 2X/Year
    Medicare will cover diabetes screening tests for individuals with hypertension, dyslipidemia, obesity, or prior identification of impaired fasting glucose or glucose intolerance. Medicare will also cover diabetes screening tests for individuals with two of the following characteristics: overweight; a family history of diabetes; 65 years of age or older; a history of gestational diabetes; and/or delivery of a baby weighing more than 9 pounds. Medicare will cover 2 screening tests per year for individuals diagnosed with pre-diabetes and one screening test per year for all others.

    • 82947 Glucose; quantitative, blood $5.98
    • 82950 Glucose, post glucose dose, including glucose $6.64
    • 82851 Glucose tolerance test (GTT) $17.99; 3 specimens
    Use ICD-9 code V77.1 (special screening for diabetes mellitus).

    Colorectal cancer screening: Once per year for those over 50
    Either, but not both of the fecal occult blood tests below are covered:

    • 82270 Colorectal cancer screening, fecal occult blood test, 1-3 simultaneous determinations $4.54 in all but 7 states
    • G0328 Colorectal cancer screening; immunoassay, fecal-occult blood test, 1-3 simultaneous determinations $22.22 in all but 9 states

    Prostate cancer screening (PSA): Once per year for all males over 50

    • G0103 PSA screening test $25.70

    Courtesy, Quality America, Inc. 4/25/2007