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Service
Who is covered
Frequency
Colorectal Cancer
Screening
All Medicare beneficiaries aged 50 and older who are:
■
At normal risk of developing colorectal cancer; or
■
At high risk of developing colorectal cancer
For colorectal cancer screening using Cologuard™—a
Multitarget Stool DNA (sDNA) Test. Only used in people who
have no signs or symptoms of CRC and who have no risk
factors associated with development of the disease.
All Medicare beneficiaries:
■
Aged 50 to 85 years;
■
Asymptomatic; and
■
At average risk of developing colorectal cancer
■
Fecal occult blood test every year
■
Flexible sigmoidoscopy once every 4 years,
or 120 months after a previous Screening
Colonoscopy for people not at high risk
■
Screening colonoscopy every 10 years (every
24 months for high risk), or 48 months after a
previous Flexible Sigmoidoscopy
■
Barium enema (as an alternative to a covered
Flexible Sigmoidoscopy) every 48 months, and
every 24 months for high risk
■
Cologuard™ Multitarget Stool DNA (sDNA) Test:
once every 3 years
Lung Cancer Screening
Counseling and Annual
Screening for Lung Cancer
with Low Dose Computed
Tomography
Certain adult Medicare beneficiaries who meet all of the
following criteria:
■
Aged 55 to 77 years and are either current smokers or have
quit smoking within the last 15 years
■
Have a tobacco smoking history of at least 30 “pack years”
(an average of one pack a day for 30 years)
■
Receive a written order from a physician or qualified non-
physician practitioner that meets certain requirements
Once per year.
Prostate Cancer Screening
All male Medicare beneficiaries aged 50 and older (coverage
begins the day after 50th birthday).
Annually for covered beneficiaries.
Glaucoma Screening
Medicare beneficiaries with diabetes mellitus, family history of
glaucoma, African-Americans aged 50 and older, or Hispanic-
Americans aged 65 and older.
Annually for covered beneficiaries.
Seasonal Influenza Virus
Vaccine and
Administration
All Medicare beneficiaries.
Once per influenza season.
Medicare may provide additional flu shots if
medically necessary.
Pneumococcal Vaccine
and Administration
All Medicare beneficiaries.
■
An initial pneumococcal vaccine to Medicare
beneficiaries who never received the vaccine
under Medicare Part B; and
■
A different, second pneumococcal vaccine
1 year after the first vaccine was administered
Hepatitis B (HBV) Vaccine
and Administration
Certain Medicare beneficiaries at intermediate or high risk for
contracting hepatitis B.
Medicare beneficiaries that are currently positive for antibodies
for hepatitis B are not eligible for this benefit.
Scheduled dosages required.
Hepatitis C Virus (HCV)
Screening
Certain adult Medicare beneficiaries who:
■
Are at high risk for HCV infection; or
■
Were born between 1945 and 1965
■
Annually only for high risk beneficiaries with
continued illicit injection drug use since the prior
negative screening test; or
■
Once in a lifetime for beneficiaries born between
1945 and 1965 who are not considered high risk
Counseling to Prevent
Tobacco Use for
Asymptomatic
Beneficiaries
Outpatient and hospitalized beneficiaries
■
Who use tobacco, regardless of whether they have signs or
symptoms of tobacco-related disease;
■
Who are competent and alert at the time that counseling is
provided; and
■
Whose counseling is furnished by a qualified physician or
other Medicare-recognized practitioner
Two cessation attempts per year. Each attempt
includes a maximum of four intermediate or
intensive sessions, up to eight sessions in a
12-month period.
Human Immunodeficiency
Virus (HIV) Screening
Beneficiaries who are at increased risk for HIV infection,
including anyone who asks for the test, or pregnant women.
Annually for beneficiaries at increased risk
Three times per pregnancy for beneficiaries who
are pregnant:
■
First, when a woman is diagnosed with
pregnancy;
■
Second, during the third trimester; and
■
Third, at labor, if ordered by the woman’s
clinician