- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Ultrasound Screening for Abdominal Aortic Aneurysm
An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as specified by the Secretary of HHS, though the national coverage redetermination process) provided for the early detection of abdominal aortic aneurysms and includes a physician’s interpretation of the results.
Coverage Criteria
Ultrasound screening for AAA is a one-time benefit for all Medicare beneficiaries with certain risk factors for AAA.
- Referral is required, but not as part of the IPPE
- Referral required from:
- Attending physician
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Referral required from:
- Risk factors include:
- Family history of AAA
- Male aged 65 to 75 who has smoked at least 100 cigarettes in lifetime
- Beneficiary who manifests other risk factors
- Beneficiary category recommended for screening by USPSTF regarding AAA, as specified by the Secretary of HHS, through the national coverage determination process
Documentation for AAA
- Physician’s order
- Patient included in one or more AAA risk categories
- Patient asymptomatic
HCPCS/CPT Coding
- 76706: Ultrasound, abdominal aortic, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
- Modifiers TC, 26
Diagnosis Coding
- ICD-10 Codes
Who Can Perform?
- Provider/supplier authorized to provide covered ultrasound diagnostic services
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers:
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denials
- No referral for ultrasound screening for AAA
- Second AAA billed for same beneficiary
Advance Beneficiary Notice of Noncoverage
- If a second AAA ultrasound screening is billed or if any of the other statutory criteria for coverage are not met, the service would be denied as a statutory (technical) denial, not a medical necessity denial
- If it cannot be determined whether or not the beneficiary has previously had an AAA screening, but all other statutory requirements have been met, the provider should issue the ABN
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 110
- MLN Matters® Article MM5235: Implementation of a One-Time Only Ultrasound Screening for Abdominal Aortic Aneurysms (AAA), Resulting from a Referral from an Initial Preventive Physical Examination
- MLN Matters® Article SE0711 Revised: Reminder – Medicare Now Provides Coverage for Eligible Medicare Beneficiaries of a One-Time Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) When Referred for this Screening as a Result of the Initial Preventive Physical Examination (“Welcome to Medicare” Physical Exam)
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/12/2023