Eliminate Health Disparities
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:
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 additional preventive services through statutory and regulatory authority.
Find more preventive services information on the USPSTF Published Recommendations webpage.
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.
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?
You may access eligibility information through the CMS Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) either directly or through your eligibility services vendor, through your Medicare Administrative Contractor (MAC) provider call center Interactive Voice Response (IVR) unit, or through your MAC provider web portal. Contact your eligibility service vendor or find your MAC’s website. Find related information in the Checking Medicare Eligibility fact sheet.
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.
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