| Physical exam ("Annual wellness exam") |
All Medicare members |
Annually |
| Alcohol abuse, intensive behavioral counseling and screening |
Medicare members who misuse alcohol but whose levels or patterns of alcohol consumption does not meet criteria for alcohol dependence |
Annual screening Up to four brief, face-to-face behavioral counseling interventions for individuals who screen positive |
| Obesity, intensive behavioral therapy - primary care setting |
Medicare members with BMI > 30 kg/m |
One face-to-face visit every week for the 1st month One face-to-face visit every other week for months 2-6 One face-to-face visit every month for months 7-12 if member meets the 3kg weight loss requirement |
| Cardiovascular disease, intensive behavioral therapy in primary care setting |
All Medicare members |
One annual face-to-face risk reduction visit |
| Sexually transmitted infections (STIs), intensive behavioral counseling and screening |
Medicare members with high risk for STIs |
Screening for Chlamydia, gonorrhea, syphilis and Hepatitis B Up to two 20 to 30 minute face-to-face counseling sessions to prevent STIs |
| Diabetes self-management training (DSMT) |
Medicare members who were recently/previously diagnosed with diabetes, or who are at risk of complications from diabetes |
Up to 10 hours of initial training within a continuous 12-month period Up to 2 hours of annual follow-up training after the initial year |
| Medical nutrition therapy (MNT) |
Medicare members diagnosed with diabetes or a renal disease |
First year: 3 hours of one-on-one counseling Subsequent years: 2 hours annually |
| Smoking and tobacco use cessation counseling |
Medicare members who use tobacco and have a disease or adverse health effects linked to tobacco use Medicare members that take certain therapeutic agents whose metabolism or dosage is affected by tobacco use |
2 cessation attempts per year |
| Clinical screenings | Who is covered | When |
|---|
| Abdominal Aortic Aneurysm (AAA) ultrasound screening |
Medicare members with certain risk factors for AAA |
Once in a lifetime |
| Bone mass measurements |
Medicare members at risk for developing Osteoporosis |
Every 2 years |
| Cardiovascular disease screenings |
All asymptomatic Medicare members |
Every 5 years |
| Colorectal cancer screening |
Medicare members age 50 and older Screening colonoscopy or Barium enema: High risk Medicare members; no minimum age |
Fecal occult: Annually Flexible sigmoidoscopy: Every 4 years, or every 10 years after having a screening colonoscopy Screening colonoscopy: Every 2 years if at high risk, or every 10 years if not at high risk Barium enema: Annually if at high risk, or every 4 years if not at high risk |
| Depression screening |
All Medicare beneficiaries |
Annual screening |
| Diabetes screening test |
Medicare members with certain risk factors for diabetes Medicare members diagnosed with pre-diabetes |
2 tests per year for members diagnosed with pre-diabetes Annually if previously tested but not diagnosed with pre-diabetes, or if never tested |
| Glaucoma screening |
Medicare members with diabetes mellitus or a family history of glaucoma African-American members age 50 or older
Hispanic-American members age 65 or older |
Annually for members who fall into one of the high risk groups |
HIV screening
|
All Medicare members
|
Annually, or, for women who are pregnant, up to 3 screenings during a pregnancy
|
| Mammography |
All female Medicare members age 35 and older |
Ages 35-39: Once Age 40 or older: Annually |
| Pap test |
All female Medicare members |
Annually if high risk or of childbearing age with abnormal Pap test within the past 3 years Every 2 years for all other women |
| Pelvic exam |
All female Medicare members |
Annually if high risk or of childbearing age with abnormal Pap test within the past 3 years Every 2 years for all other women |
| Prostate cancer screening |
All male Medicare members age 50 or older |
Annually |
| Immunizations | Who is covered | When |
|---|
Flu
Influenza |
All Medicare members |
Annually |
Pneumococcal
Pneumonia |
All Medicare members |
Once in a lifetime |
HepB
Hepatitis B |
Medium to high risk Medicare members |
Scheduled dosages required |
