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Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011
Guidance for CMS stakeholders on data regarding Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 27, 2012
Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011
Data: Through Week 47 of 2011
| State | Enrolled in Medicare Part B | Enrolled in Medicare Part B, no longer in first 12 months | All Free Services | Annual Wellness - New Service | ||
|---|---|---|---|---|---|---|
| # | % | # | % | |||
| Nation | 34,774,014 | 32,069,756 | 24,175,608 | 69.5% | 1,931,927 | 6.0% |
| Alabama | 681,683 | 630,333 | 473,000 | 69.4% | 14,531 | 2.3% |
| Alaska | 66,041 | 60,055 | 35,584 | 53.9% | 2,346 | 3.9% |
| American Samoa | 299 | 230 | 187 | 62.5% | 16 | 7.0% |
| Arizona | 594,645 | 540,969 | 394,180 | 66.3% | 48,896 | 9.0% |
| Arkansas | 462,109 | 430,029 | 298,511 | 64.6% | 12,936 | 3.0% |
| California | 2,978,780 | 2,723,555 | 1,962,809 | 65.9% | 139,396 | 5.1% |
| Colorado | 415,815 | 377,216 | 260,715 | 62.7% | 31,608 | 8.4% |
| Connecticut | 443,167 | 413,436 | 323,575 | 73.0% | 55,329 | 13.4% |
| Delaware | 146,776 | 136,412 | 108,762 | 74.1% | 7,579 | 5.6% |
| District of Columbia | 64,451 | 59,255 | 40,758 | 63.2% | 2,581 | 4.4% |
| Florida | 2,372,727 | 2,193,342 | 1,741,818 | 73.4% | 170,581 | 7.8% |
| Georgia | 989,435 | 908,134 | 682,342 | 69.0% | 55,842 | 6.1% |
| Guam | 9,339 | 8,361 | 4,759 | 51.0% | 55 | 0.7% |
| Hawaii | 110,479 | 99,730 | 73,710 | 66.7% | 1,499 | 1.5% |
| Idaho | 167,325 | 154,480 | 101,575 | 60.7% | 9,262 | 6.0% |
| Illinois | 1,660,085 | 1,543,440 | 1,167,619 | 70.3% | 76,145 | 4.9% |
| Indiana | 840,368 | 779,421 | 581,345 | 69.2% | 43,725 | 5.6% |
| Iowa | 452,783 | 424,735 | 321,805 | 71.1% | 20,001 | 4.7% |
| Kansas | 385,631 | 359,349 | 259,609 | 67.3% | 16,341 | 4.5% |
| Kentucky | 641,919 | 596,271 | 442,465 | 68.9% | 22,170 | 3.7% |
| Louisiana | 525,291 | 484,343 | 354,126 | 67.4% | 11,886 | 2.5% |
| Maine | 229,377 | 214,947 | 156,305 | 68.1% | 24,829 | 11.6% |
| Maryland | 698,771 | 644,319 | 499,372 | 71.5% | 35,684 | 5.5% |
| Massachussets | 837,812 | 775,595 | 620,537 | 74.1% | 109,098 | 14.1% |
| Michigan | 1,298,339 | 1,196,317 | 927,004 | 71.4% | 108,031 | 9.0% |
| Minnesota | 430,336 | 397,381 | 281,725 | 65.5% | 18,135 | 4.6% |
| Mississippi | 461,523 | 430,116 | 302,617 | 65.6% | 12,167 | 2.8% |
| Missouri | 788,909 | 731,669 | 540,630 | 68.5% | 29,646 | 4.1% |
| Montana | 147,053 | 136,409 | 88,276 | 60.0% | 8,086 | 5.9% |
| Nebraska | 245,884 | 229,929 | 162,707 | 66.2% | 8,511 | 3.7% |
| Nevada | 245,734 | 222,140 | 150,196 | 61.1% | 8,698 | 3.9% |
| New Hampshire | 206,476 | 190,806 | 144,180 | 69.8% | 17,378 | 9.1% |
| New Jersey | 1,138,285 | 1,054,368 | 830,732 | 73.0% | 76,613 | 7.3% |
| New Mexico | 230,643 | 211,648 | 137,294 | 59.5% | 9,806 | 4.6% |
| New York | 1,994,329 | 1,834,926 | 1,410,533 | 70.7% | 127,691 | 7.0% |
| North Carolina | 1,268,351 | 1,174,717 | 924,937 | 72.9% | 87,867 | 7.5% |
| North Dakota | 98,432 | 92,466 | 63,677 | 64.7% | 4,171 | 4.5% |
| Northern Marianas | 1,520 | 1,354 | 646 | 42.5% | 3 | 0.2% |
| Ohio | 1,257,311 | 1,155,325 | 864,243 | 68.7% | 50,178 | 4.3% |
| Oklahoma | 516,344 | 478,729 | 333,946 | 64.7% | 11,627 | 2.4% |
| Oregon | 365,397 | 331,610 | 231,138 | 63.3% | 16,674 | 5.0% |
| Pennsylvania | 1,364,402 | 1,257,544 | 956,993 | 70.1% | 50,170 | 4.0% |
| Puerto Rico | 112,654 | 94,016 | 61,755 | 54.8% | 190 | 0.2% |
| Rhode Island | 110,797 | 101,713 | 80,714 | 72.8% | 16,409 | 16.1% |
| South Carolina | 674,830 | 622,840 | 478,168 | 70.9% | 31,812 | 5.1% |
| South Dakota | 124,261 | 116,444 | 81,349 | 65.5% | 4,437 | 3.8% |
| Tennessee | 811,487 | 747,149 | 563,541 | 69.4% | 42,384 | 5.7% |
| Texas | 2,437,097 | 2,231,833 | 1,688,860 | 69.3% | 135,012 | 6.0% |
| US Possessions | 41 | 38 | 2 | 4.9% | 0 | 0.0% |
| Unknown | 228,745 | 39,905 | 19,501 | 8.5% | 186 | 0.5% |
| Utah | 181,506 | 166,122 | 115,490 | 63.6% | 8,848 | 5.3% |
| Vermont | 106,793 | 99,144 | 71,342 | 66.8% | 8,446 | 8.5% |
| Virgin Islands | 16,082 | 14,634 | 7,657 | 47.6% | 284 | 1.9% |
| Virginia | 972,636 | 899,990 | 694,321 | 71.4% | 45,245 | 5.0% |
| Washington | 720,156 | 661,985 | 465,335 | 64.6% | 41,020 | 6.2% |
| West Virginia | 299,832 | 277,397 | 199,505 | 66.5% | 6,658 | 2.4% |
| Wisconsin | 639,824 | 590,678 | 440,011 | 68.8% | 30,626 | 5.2% |
| Wyoming | 77,378 | 71,722 | 41,507 | 53.6% | 2,399 | 3.3% |
*Data displayed for the most recent months may be subject to fluctuations resulting from delays in Medicare claims processing. These delays arise when there is a gap between the day a service is rendered and the day a medical provider seeks payment for that service from CMS. Generally, 90 percent of claims are received and processed by CMS within 12 weeks of service.
# - Number of beneficiaries that have received at least one preventive service in 2011 to date.
% - Share of beneficaries with traditional Medicare that have received at least one preventive service in 2011 to date.
Note: Certain services are subject to additional eligibility criteria, as outlined in the "Specifications" section below. For example, a beneficiary must be enrolled in Part B for more than 12 months to be eligible for an Annual Wellness exam.
Specifications
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| Note: For this analysis, services are determined by billed line items with the CPT/HCPCS codes specified in the appendix. | |||
| Categories of Preventive Services | ||
|---|---|---|
| New Service |
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| Newly Waived |
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| Previously Waived |
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| Population: Beneficiaries with traditional Medicare. | ||
|---|---|---|
| Note: For the following services, the population is limited to beneficiares who meet certain additional eligibility criteria. | ||
| Annual Wellness Visit - All Part B enrolled, no longer within 12 months of enrollment start date | ||
| Welcome to Medicare Exam - All Part B enrolled, within 12 months of enrollment start date and enrolled on or after 1/1/2005. | ||
| Colorectal Cancer Screening - All Part B enrolled aged 50+ | ||
| Mammogram - All Part B enrolled women, aged 35+ | ||
| Pap Test - All Part B enrolled women | ||
| Pelvic Exam - All Part B enrolled women | ||
| Prostate Cancer Screening - All Part B enrolled men, aged 50+ | ||
Appendix: List of Preventive Services and CPT/HCPCS Codes
| Preventive Service | CPT/HCPCS Code | Description | Additional Criteria | USPSTF Rating |
|---|---|---|---|---|
| Welcome to Medicare Exam (IPPE) | G0402 | Initial preventive physical examination; face to face visit. | Services limited to new beneficiary during the first 12 months of Medicare enrollment, enrolled on or after 1/1/2005. | *Not Rated |
| Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) | G0389 | Ultrasound, B-scan and /or real time with image documentation; for abdominal aortic aneurysm (AAA) ultrasound screening | B | |
| Cardiovascular Disease Screening | 80061 | Lipid panel | Excludes beneficiaries with cardiovascular disease. | A |
| 82465 | Cholesterol, serum or whole blood, total | |||
| 83718 | Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol) | |||
| 84478 | Triglycerides | |||
| Diabetes Screening Tests | 82947 | Glucose; quantitative, blood (except reagent strip) | Excludes beneficiaries with diabetes. | B |
| 82950 | Glucose; post glucose dose (includes glucose) | |||
| 82951 | Glucose; tolerance test (gtt), three specimens (includes glucose) | *Not Rated | ||
| Medical Nutrition Therapy (MNT) Services | 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | Services limited to beneficiaries with diabetes, renal disease, or kidney transplant in the previous three years. | B |
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | |||
| 97804 | Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes | |||
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes | B | ||
| G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes | |||
| Screening Pap Test | G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | Services limited to women. | A |
| G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician | |||
| G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | A | ||
| G0143 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision | A | ||
| G0144 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision | A | ||
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | A | ||
| G0147 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision | A | ||
| G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening | A | ||
| P3000 | Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision | |||
| P3001 | Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician | |||
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | |||
| Screening Pelvic Exam | G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | Services limited to women. | A |
| Screening Mammography | 77052 | Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) | Services limited to women aged 35 or older. | B |
| 77057 | Screening mammography, bilateral (2-view film study of each breast) | |||
| G0202 | Screening mammography, producing direct digital image, bilateral, all views | |||
| Bone Mass Measurement | G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) | B | |
| 77078 | Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | |||
| 77079 | Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) | |||
| 77080 | Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | |||
| 77081 | Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) | |||
| 77083 | Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites | |||
| 76977 | Ultrasound bone density measurement and interpretation, peripheral site(s), any method | B | ||
| Colorectal Cancer Screening | G0104 | Colorectal cancer screening; flexible sigmoidoscopy | Services limited to beneficiaries aged 50 or older. | A |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | |||
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | |||
| 82270 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive | |||
| G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous | |||
| Prostate Cancer Screening | G0103 | Prostate cancer screening; prostate specific antigen test (PSA) | Services limited to men aged 50 or older. | D |
| Influenza Virus Vaccine | 90655 | Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use | B | |
| 90656 | Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use | |||
| 90657 | Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use | |||
| 90660 | Influenza virus vaccine, live, for intranasal use | |||
| 90662 | Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | |||
| Q2035 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) | |||
| Q2036 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) | |||
| Q2037 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) | |||
| Q2038 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) | |||
| Q2039 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) | |||
| G0008 | Administration of influenza virus vaccine | |||
| Pneumococcal Vaccine | 90669 | Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use | B | |
| 90670 | Pneumococcal conjugate vaccine, 13 valent, for intramuscular use. | |||
| 90732 | Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use | |||
| G0009 | Administration of pneumococcal vaccine | |||
| Hepatitis B Vaccine | 90740 | Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use | A | |
| 90743 | Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use | |||
| 90744 | Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use | |||
| 90746 | Hepatitis B vaccine, adult dosage, for intramuscular use | |||
| 90747 | Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use | |||
| G0010 | Administration of hepatitis B vaccine | A | ||
| HIV Screening | G0432 | Infectious agent antigen detection by enzyme immunoassay (EIA) technique, qualitative or semi-qualitative, multiple-step method, HIV-1 or HIV-2, screening | A | |
| G0433 | Infectious agent antigen detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody, HIV-1 or HIV-2, screening | |||
| G0435 | Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2 , screening | |||
| Smoking and Tobacco Cessation | G0436 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes | A | |
| G0437 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes | |||
| Annual Wellness Visit | G0438 | Annual wellness visit, including PPPS, first visit | Services limited to beneficiaries no longer in the first 12 months of Medicare enrollment. | *Not Rated |
| G0439 | Annual wellness visit, including PPPS, subsequent visit |
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