MLN Educational Tool: Knowledge, Resources, Training
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Advance Health Equity


Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health:



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Telehealth Eligible Services


Note: This symbol (Represents a Teleheatlh Service) beside a service description
means it’s telehealth eligible.


FAQs

How do I determine the last date a patient got a preventive service so I know if they’re eligible to get the next service and it won’t deny due to frequency edits?

Find out how to check for eligibility. You may access eligibility information through the CMS HIPAA Eligibility Transaction System (HETS) either directly or through your:

  • Eligibility services vendor
  • Medicare Administrative Contractor (MAC) provider call center Interactive Voice Response (IVR) unit
  • MAC provider web portal

Contact your eligibility service vendor or find your MAC's website.

My patients don’t follow up on routine preventive care. How can I help them remember when they’re due for their next preventive service?

We offer a Preventive Services Checklist so they can track their preventive services.

When can CMS add new Medicare preventive services?

We may add preventive services coverage through the National Coverage Determination (NCD) process if the service is:

  • Reasonable and necessary for prevention or early detection of illness or disability
  • United States Preventive Services Task Force (USPSTF) recommended with grade A or B
  • Appropriate for individuals entitled to Part A benefits or enrolled under Medicare Part B

We may also add preventive services through statutory and regulatory authority.

The USPSTF Published Recommendations webpage has more preventive services information.

What’s a primary care setting?

We define a primary care setting as a place where clinicians deliver integrated, accessible health care services, responsible for addressing most patient health care needs, developing a sustained patient partnership, and practicing in the context of family and community. Under this direction, we don’t consider emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, and hospices as primary care settings.

Resources

Disclaimers

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Medicare Learning Network® Content & Product Disclaimer, and Department of Health & Human Services Disclosure

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).