Wellness Care Coverage Enhanced Under 2011 Medicare Physician Fee Schedule
Medicare coverage for wellness visits and other preventative services will be enhanced under the newly-released 2011 Medicare Physician’s Fee Schedule ("PFS").
The new PFS incorporates many of the mandates imposed by this year’s health reform bill, which emphasizes preventative medicine and wellness as a strategy to combat high costs of care. Starting January 1, 2011, beneficiaries will be able to obtain many preventive screenings and services free of charge, including any co-pays or deductibles.
Some of the new services to be offered to beneficiaries free of charge include:
- An annual “wellness visit,” where physicians will be able to update a patient’s care plan, screen for impairments, obtain information such as height, weight and blood pressure, and coordinate other tests and screenings based on the patient’s medical/family histories.
- Screening tests for various cancers, such as annual mammograms for women 40 and older, and one baseline mammogram for women between 35 and 39; pap tests and pelvic exams, annually for women at high risk for cervical or vaginal cancers and biannually otherwise; annual prostate cancer screening tests (excluding digital rectal examinations) for men over 50, and colorectal cancer screening tests (excluding barium enemas) generally for individuals over 50, except for colonoscopies which have no minimum age requirement.
- Diabetes screening tests for beneficiaries with hypertension, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar. However, diabetes self-management training services remain subject to coinsurance and deductibles.
- Cardiovascular disease screening blood tests (but not electrocardiograms) to test cholesterol, lipid and triglyceride levels are fully covered once every five years.
- Bone density tests, smoking cessation counseling, and medical nutrition therapy for individuals with diabetes, kidney disease or a kidney transplant.
- Additionally, under a National Coverage Determination issued in August of 2010, Medicare will fully cover HIV testing for high-risk populations.
- Vaccinations for pneumonia, influenza and hepatitis B
Physicians who treat Medicare beneficiaries should expect to see a sharp increase in requests for these types of preventative services in 2011. For more information about the 2011 PFS, contact an experience health care attorney.
