Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 21, 2020

Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases. Talk to your patients about which preventive services are right for them and how often they need them.

If you’re a person with Medicare, learn about all preventive services.

Learn more about billing for Medicare-covered preventive services:

Shots & vaccines

• COVID-19 vaccine toolkit
• Flu shot
• Hepatitis B shot
• Pneumococcal shot
• In-Home Vaccine Administration: Additional Payment
• Medicare Benefit Policy Manual – Chapter 15: Section 50.4.4.2 – Immunizations (PDF)
• Roster Billing: COVID-19, Flu, & Pneumococcal vaccines
• Skilled Nursing Facility: Billing Medicare for Respiratory Vaccines (PDF)
• Medicare Part D Vaccines (PDF)

Wellness visits

• Annual wellness visits
• Initial preventive physical exam
• Medicare wellness visits educational tool

Diabetes-related services

• Diabetes screening
• Diabetes Self-Management Training (DSMT)
• Medicare Diabetes Self-Management Training (PDF)
• Medicare Diabetes Prevention Program (MDPP)
• Pre-Diabetes Services: Referring Patients to the MDPP (PDF)

Tests & screenings

• Bone mass measurements
• Cardiovascular disease screening tests
• Cervical cancer screenings with Human Papillomavirus (HPV) tests
• Colorectal cancer screening tests
• Glaucoma screening
• Hepatitis B screening
• Hepatitis C screening
• HIV screening
• Lung cancer screening
• Mammography screening
• Pap tests screening
• Prolonged preventive services
• Prostate cancer screening
• Screening Pap Tests & Pelvic Exams (PDF)
• Screening pelvic exams, including clinical breast exam
• Sexually transmitted infection (STI) screening
• Ultrasound Abdominal Aortic Aneurysm (AAA) screening

Counseling & therapies

• Alcohol misuse screenings & counseling
• Counseling to prevent tobacco use
• High intensity behavioral counseling to prevent STIs
• Intensive behavioral therapy for cardiovascular disease
• Intensive behavioral therapy for obesity
• Medical nutrition therapy

Mental health services

• Medicare & Mental Health Coverage (PDF)
• Depression screening

Resources

• Medicare Preventive Services educational tool
• Medicare Claims Processing Manual, Chapter 18 – Preventive and Screening Services (PDF)

 

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.