Abdominal aortic aneurysm (AAA) is a killer. In 2009, AAA directly caused nearly 11,000 deaths and contributed to another 17,000. The reason that this is such a deadly disease is because there are very few warning signs that someone has this condition.
What happens is the walls of the aorta – the main vessel that carries blood throughout the body – can become weakened over time, causing the walls to stretch and become thin. If the vessel stretches too much it can burst. When it bursts you’re in big trouble. There are certain things that put one at risk for developing AAA, like smoking and high blood pressure, but one of the big ones is family history. You can control smoking and high blood pressure, but did you ever try to change your family history? Good luck with that.
In 2005, the United States Preventative Services Task Force (USPSTF) recommended screening evaluations for AAA, and effective January 1, 2007, Medicare began paying for a one-time AAA screening for males who have smoked at least 100 cigarettes and anyone with a family history of AAA. Initially the screening was allowed for new beneficiaries only – those who were already enrolled in the Medicare program prior to 1/1/2007 did not receive this benefit. Additionally, the screening had to be ordered by a primary care physician during the initial preventive physical exam (IPPE) visit, and it had to be performed within six months of enrolling in Medicare. Needless to say, this seriously restricted access to the program and the number of beneficiaries using this valuable benefit was low.
Medicare created a procedure code for this evaluation – G0389. This code globally reimbursed approximately $200 under most Medicare carriers. In 2014, someone thought it was a good idea to revalue this code at much lower reimbursement resulting in a significant drop in reimbursement to approximately $80. The drop in reimbursement, the confusion and lack of knowledge amongst beneficiaries and physicians about this benefit, and the limitations on coverage almost eliminated this valuable benefit.
So in 2014 Medicare announced some changes to the AAA screening benefit. Starting on January 1, 2015, beneficiaries between 65-75 years of age, regardless of when they enrolled in Medicare are eligible if they are male and have ever smoked, or they are either gender and have a relative who has had an AAA. The beneficiary still needs a referral for the exam from a qualified and appropriate healthcare provider but no longer does the physician have to be a primary care physician. And while I forgot to mention earlier that the beneficiary was responsible for any co-pay, the beneficiary will have no out of pocket costs come January 2015.
And more good news! The Medicare Physician Fee Schedule has returned AAA reimbursement to pre-2014 levels, meaning that there is a 76% increase in the global reimbursement in 2015 compared to 2014 levels.
It is important to note that to be eligible for reimbursement that the provider must provide an interpretation prepared by a physician. I know that this sounds like a no-brainer, but remember there are “screening” companies and facilities out there that provide AAA screening, and Medicare will not reimburse for a study that is not interpreted appropriately.
So just to be clear, starting in 2015, here are the eligibility requirements for AAA Screening:
- Eligible beneficiary means an individual who has not been previously furnished an ultrasound screening for an abdominal aortic aneurysm under Medicare program
- Is included in at least one of the following risk categories:
- Has a family history of an abdominal aortic aneurysm
- Is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
- Is an individual who manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force regarding abdominal aortic aneurysms, as specified by the Secretary through a national coverage determination process
For you physicians out there, please ask your Medicare patients if they’ve had an AAA screening, and if they haven’t, refer them to an accredited vascular lab that uses credentialed technologists – you could save their lives.
For you Medicare beneficiaries reading this, ask your physician about this incredibly valuable benefit. After all it is a free benefit that could save your life.
If you have a parent or sibling or friend who is enrolled in Medicare and is over 65, tell them about this valuable service available to them. Save a life.
Aortic Aneurysm at Medline Plus. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=abdominal+aortic+aneurysm
2014 AAA Screening Revision from CMS http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R3096CP.pdf
2007 AAA Screening Announcement from CMS http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5235.pdf
AAA Fact Sheet from the Centers for Disease Controls Prevention http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_aortic_aneurysm.htm