Once in a lifetime abdominal aortic aneurysm (AAA) screening is only covered under certain specified conditions.
When billing for AAA screenings, the following ICD-10 codes should be billed:
* Z13.6 for the encounter for screening for cardiovascular disorders and either
** The most appropriate code for tobacco usage: Z87.891, F17.210, F17.211, F17.213, F17.218 and F17.219 OR
* Z84.89 for family history of other specified conditions
Note: CPT® code 76706 is the only ultrasound service that is payable for AAA screening under Medicare services. No other CPT®/HCPCS codes are covered.
Per the CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 110.2 and 110.3.2,
Payment may be made for a one-time ultrasound screening for AAA for beneficiaries who meet the following criteria:
(i) receives a referral for such an ultrasound screening from the beneficiary’s attending physician, physician assistant, nurse practitioner or clinical nurse specialist;
(ii) receives such ultrasound screening from a provider or supplier who is authorized to provide covered ultrasound diagnostic services;
(iii) has not been previously furnished such an ultrasound screening under the Medicare Program; and
(iv) is included in at least one of the following risk categories-
(I) has a family history of abdominal aortic aneurysm;
(II) is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime; or
(III) is a beneficiary who manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force regarding AAA, as specified by the Secretary of Health and Human Services, through the national coverage determination process.***
*For risk category (I) note that Z84.89 is an “other specified” code and requires that the condition be reflected in the medical record, therefore family history of abdominal aortic aneurysm must be documented in the medical record.
**For risk category (II)
***For risk category (III) USPST does not currently have any additional screening recommendations at B or above grade at this time.
Effective for services furnished on or after January 1, 2017, the following code, modifiers, and type of service (TOS) are used for AAA screening services:
CPT® code 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
Short Descriptor: Us abdl aorta screen AAA
Modifiers: TC, 26
Bill Types: 12x, 13x, 22x, 23x, 71x, 73x, 85x