Medicare now covers heart disease screening

The program adds the intensive therapy service to its list of preventive care that carries no additional out-of-pocket costs.

By Charles Fiegl — Posted Nov. 23, 2011

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The Medicare program has expanded its coverage policy manual to include annual visits that screen for hypertension and prevent cardiovascular disease.

The Centers for Medicare & Medicaid Services will cover office visits with primary care physicians to discuss how to prevent heart disease, the agency announced Nov. 8. The new exam will join a list of preventive services covered by the Medicare program at no additional out-of-pocket cost to the beneficiary.

"Access to preventive services helps Medicare beneficiaries identify health risk factors and disease early to provide greater opportunities for early treatment," said CMS Administrator Donald M. Berwick, MD.

The new service aims to prevent hypertension, coronary heart disease, heart failure and stroke. The Medicare agency outlined three elements for intensive behavioral therapy for cardiovascular disease risk in a national coverage decision memo (link).

The components are:

  • Encouraging aspirin use for the primary prevention of cardiovascular disease when benefits outweigh risks for men ages 45 to 79 and women 55 to 79.
  • Screening for high blood pressure in adults over age 18.
  • Counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advanced age, and other known risk factors for cardiovascular and diet-related chronic disease.

The service can be provided by primary care physicians, such as family physicians or internists, or nurse practitioners in an office setting. CMS has created a temporary code, G0446, to bill the service. It would pay about $20 to $25, according to 2012 physician fee schedule data posted on the CMS website.

The new service does not change coverage for patients diagnosed with cardiovascular disease who are receiving assessment and intervention services, CMS said. In March, the American College of Cardiology had commended CMS for using its authority to expand coverage of preventive services, then-ACC president Ralph Brindis, MD, wrote in a letter to the agency.

"The ACC strongly supports efforts to prevent cardiovascular disease, including coverage for services with strong evidence demonstrating a correlation between the service and a decline in the number of individuals suffering from cardiovascular disease," Dr. Brindis said.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn