January 2007 | Vol. 25, No. 1

Clarification on AAA Screening Provision Under the DRA

SVU recently received clarification from CMS that the order for an AAA screening exam under the DRA has to originate from the Initial Preventative Physical Examination (IPPE) provider and only when it occurs within the window of opportunity in which the new Medicare Beneficiary is eligible for this examination. Thus, a person who is already a Medicare beneficiary is not eligible for this AAA screening benefit. The code for the AAA screening exam is G0389. SVU members are urged to check the websites of their Medicare carriers to get the appropriate reimbursement rate for this exam.

The AAA screening provision also limits eligibility to those individuals who are at risk for AAAs, which is described as anyone with a family history of AAAs; a man aged 65 to 75 who has smoked at least 100 cigarettes in his lifetime; and any other individual who manifests risk factors that are recommended for screening by the U.S. Preventive Services Task Force. Thus, these eligibility guidelines will greatly limit utilization of this AAA screening exam.

Based on the numbers of new Medicare Beneficiaries coupled with current percentages of those who take advantage of the IPPE and the inclusion criteria, SVU has heard estimates as low as 30,000 AAA screening exams nationally the first year. Such a level will not inundate the system.