CMS Pub. 100-04, ch. 19, § 100.13

Payment Policy

(Rev. 2075, Issued: 10-28-10, Effective: 01-01-10, Implementation: 01-28-11)

Effective January 1, 2005, payment is made by the A/B MAC (A) based on the AIR to

IHS providers, excluding CAHs, for screening and preventive services covered under

§630 of the MMA, indefinitely extended by §2902 of the ACA. Payment is made to

CAHs based on cost. Screening and preventive services covered under §630 of the

MMA, indefinitely extended by §2902 of the ACA, include:

• Pelvic exam;

• Glaucoma screening;

• Bone mass measurements;

• Prostate cancer screening;

• Colorectal cancer screening;

• Screening pap smear;

• Screening mammography;

• Cardiovascular screening blood tests;

• Diabetes screening tests;

• DSMT;

• MNT;

• Initial physician physical exam (IPPE) - Welcome to Medicare; and

• Smoking and tobacco-use cessation (counseling/screening).

See Chapter 18, of Pub. 100-04, Medicare Claims Processing Manual, for more

information on screening and preventive services.