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Preventive

Beneficiaries Utilizing Free Preventive Services by State, Year-to-Date 2011

Data: Through Week 47 of 2011

 

StateEnrolled in Medicare Part BEnrolled in Medicare Part B, no longer in first 12 monthsAll Free ServicesAnnual Wellness - New Service
#%#%
Nation34,774,01432,069,75624,175,60869.5%1,931,9276.0%
Alabama681,683630,333473,00069.4%14,5312.3%
Alaska66,04160,05535,58453.9%2,3463.9%
American Samoa29923018762.5%167.0%
Arizona594,645540,969394,18066.3%48,8969.0%
Arkansas462,109430,029298,51164.6%12,9363.0%
California2,978,7802,723,5551,962,80965.9%139,3965.1%
Colorado415,815377,216260,71562.7%31,6088.4%
Connecticut443,167413,436323,57573.0%55,32913.4%
Delaware146,776136,412108,76274.1%7,5795.6%
District of Columbia64,45159,25540,75863.2%2,5814.4%
Florida2,372,7272,193,3421,741,81873.4%170,5817.8%
Georgia989,435908,134682,34269.0%55,8426.1%
Guam9,3398,3614,75951.0%550.7%
Hawaii110,47999,73073,71066.7%1,4991.5%
Idaho167,325154,480101,57560.7%9,2626.0%
Illinois1,660,0851,543,4401,167,61970.3%76,1454.9%
Indiana840,368779,421581,34569.2%43,7255.6%
Iowa452,783424,735321,80571.1%20,0014.7%
Kansas385,631359,349259,60967.3%16,3414.5%
Kentucky641,919596,271442,46568.9%22,1703.7%
Louisiana525,291484,343354,12667.4%11,8862.5%
Maine229,377214,947156,30568.1%24,82911.6%
Maryland698,771644,319499,37271.5%35,6845.5%
Massachussets837,812775,595620,53774.1%109,09814.1%
Michigan1,298,3391,196,317927,00471.4%108,0319.0%
Minnesota430,336397,381281,72565.5%18,1354.6%
Mississippi461,523430,116302,61765.6%12,1672.8%
Missouri788,909731,669540,63068.5%29,6464.1%
Montana147,053136,40988,27660.0%8,0865.9%
Nebraska245,884229,929162,70766.2%8,5113.7%
Nevada245,734222,140150,19661.1%8,6983.9%
New Hampshire206,476190,806144,18069.8%17,3789.1%
New Jersey1,138,2851,054,368830,73273.0%76,6137.3%
New Mexico230,643211,648137,29459.5%9,8064.6%
New York1,994,3291,834,9261,410,53370.7%127,6917.0%
North Carolina1,268,3511,174,717924,93772.9%87,8677.5%
North Dakota98,43292,46663,67764.7%4,1714.5%
Northern Marianas1,5201,35464642.5%30.2%
Ohio1,257,3111,155,325864,24368.7%50,1784.3%
Oklahoma516,344478,729333,94664.7%11,6272.4%
Oregon365,397331,610231,13863.3%16,6745.0%
Pennsylvania1,364,4021,257,544956,99370.1%50,1704.0%
Puerto Rico112,65494,01661,75554.8%1900.2%
Rhode Island110,797101,71380,71472.8%16,40916.1%
South Carolina674,830622,840478,16870.9%31,8125.1%
South Dakota124,261116,44481,34965.5%4,4373.8%
Tennessee811,487747,149563,54169.4%42,3845.7%
Texas2,437,0972,231,8331,688,86069.3%135,0126.0%
US Possessions413824.9%00.0%
Unknown228,74539,90519,5018.5%1860.5%
Utah181,506166,122115,49063.6%8,8485.3%
Vermont106,79399,14471,34266.8%8,4468.5%
Virgin Islands16,08214,6347,65747.6%2841.9%
Virginia972,636899,990694,32171.4%45,2455.0%
Washington720,156661,985465,33564.6%41,0206.2%
West Virginia299,832277,397199,50566.5%6,6582.4%
Wisconsin639,824590,678440,01168.8%30,6265.2%
Wyoming77,37871,72241,50753.6%2,3993.3%

*Data displayed for the most recent months may be subject to fluctuations resulting from delays in Medicare claims processing. These delays arise when there is a gap between the day a service is rendered and the day a medical provider seeks payment for that service from CMS. Generally, 90 percent of claims are received and processed by CMS within 12 weeks of service.

# - Number of beneficiaries that have received at least one preventive service in 2011 to date.

% - Share of beneficaries with traditional Medicare that have received at least one preventive service in 2011 to date.

Note: Certain services are subject to additional eligibility criteria, as outlined in the "Specifications" section below. For example, a beneficiary must be enrolled in Part B for more than 12 months to be eligible for an Annual Wellness exam.

Specifications

Free Preventive Services
  • Annual Wellness Visit
 
  • Smoking Cessation Counseling
  • Bone Mass Measurement
 
  • HIV Screening
  • Cardiovascular Screening
 
  • Hepatitis B Vaccine
  • Colorectal Cancer Screening
 
  • Welcome to Medicare Exam
  • Diabetes Screening
 
  • Mammogram
  • Medical Nutrition Therapy
 
  • Pneumococcal Vaccine
  • Pap Test
 
  • Prostate Cancer Screening (PSA)
  • Pelvic Exam
 
  • Ultrasound Screening for
  • Seasonal Influenza Vaccine
 
  • Abdominal Aortic Aneurysm
 
Note: For this analysis, services are determined by billed line items with the CPT/HCPCS codes specified in the appendix.

 

Categories of Preventive Services  
New Service 
  • Services that were introduced in January 2011 with no co-insurance or deductible
Newly Waived 
  • Services that previously had co-insurance or deductible, but waived in January 2011
Previously Waived 
  • Services that had no co-insurance or deductible prior to and after January 2011

 

Population: Beneficiaries with traditional Medicare.
   
Note: For the following services, the population is limited to beneficiares who meet certain additional eligibility criteria.
Annual Wellness Visit - All Part B enrolled, no longer within 12 months of enrollment start date
Welcome to Medicare Exam - All Part B enrolled, within 12 months of enrollment start date and enrolled on or after 1/1/2005.
Colorectal Cancer Screening - All Part B enrolled aged 50+
Mammogram - All Part B enrolled women, aged 35+
Pap Test - All Part B enrolled women
Pelvic Exam - All Part B enrolled women
Prostate Cancer Screening - All Part B enrolled men, aged 50+

Appendix: List of Preventive Services and CPT/HCPCS Codes

Preventive ServiceCPT/HCPCS CodeDescriptionAdditional CriteriaUSPSTF Rating
Welcome to Medicare Exam (IPPE)G0402Initial preventive physical examination; face to face visit.Services limited to new beneficiary during the first 12 months of Medicare enrollment, enrolled on or after 1/1/2005.*Not Rated
 
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)G0389Ultrasound, B-scan and /or real time with image documentation; for abdominal aortic aneurysm (AAA) ultrasound screening B
Cardiovascular Disease Screening80061Lipid panelExcludes beneficiaries with cardiovascular disease.A
82465Cholesterol, serum or whole blood, total
83718Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol)
84478Triglycerides
Diabetes Screening Tests82947Glucose; quantitative, blood (except reagent strip)Excludes beneficiaries with diabetes.B
82950Glucose; post glucose dose (includes glucose)
82951Glucose; tolerance test (gtt), three specimens (includes glucose)*Not Rated
Medical Nutrition Therapy (MNT) Services97802Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutesServices limited to beneficiaries with diabetes, renal disease, or kidney transplant in the previous three years.B
97803Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
G0270Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutesB
G0271Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
Screening Pap TestG0123Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervisionServices limited to women.A
G0124Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
G0141Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physicianA
G0143Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervisionA
G0144Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervisionA
G0145Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervisionA
G0147Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervisionA
G0148Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreeningA
P3000Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
P3001Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician
Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
Screening Pelvic ExamG0101Cervical or vaginal cancer screening; pelvic and clinical breast examinationServices limited to women.A
Screening Mammography77052Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure)Services limited to women aged 35 or older.B
77057Screening mammography, bilateral (2-view film study of each breast)
G0202Screening mammography, producing direct digital image, bilateral, all views
Bone Mass MeasurementG0130Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) B
77078Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)
77079Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)
77080Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)
77081Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)
77083Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites
76977Ultrasound bone density measurement and interpretation, peripheral site(s), any methodB
Colorectal Cancer ScreeningG0104Colorectal cancer screening; flexible sigmoidoscopyServices limited to beneficiaries aged 50 or older.A
G0105Colorectal cancer screening; colonoscopy on individual at high risk
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
82270Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive
G0328Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
Prostate Cancer ScreeningG0103Prostate cancer screening; prostate specific antigen test (PSA)Services limited to men aged 50 or older.D
Influenza Virus Vaccine90655Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use B
90656Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
90657Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
 
90660Influenza virus vaccine, live, for intranasal use
90662Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
 
Q2039Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
G0008Administration of influenza virus vaccine
Pneumococcal Vaccine90669Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use B
90670Pneumococcal conjugate vaccine, 13 valent, for intramuscular use.
90732Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
G0009Administration of pneumococcal vaccine
Hepatitis B Vaccine90740Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use A
90743Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746Hepatitis B vaccine, adult dosage, for intramuscular use
90747Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
G0010Administration of hepatitis B vaccineA
HIV ScreeningG0432Infectious agent antigen detection by enzyme immunoassay (EIA) technique, qualitative or semi-qualitative, multiple-step method, HIV-1 or HIV-2, screening A
 
G0433Infectious agent antigen detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody, HIV-1 or HIV-2, screening
G0435Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2 , screening
Smoking and Tobacco CessationG0436Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes A
 
G0437Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
Annual Wellness VisitG0438Annual wellness visit, including PPPS, first visitServices limited to beneficiaries no longer in the first 12 months of Medicare enrollment.*Not Rated
G0439Annual wellness visit, including PPPS, subsequent visit