Diagnostic and Screening Mammograms Performed With New Technologies

Section 104 of the Benefits Improvement and Protection Act 2000, (BIPA) entitled "Modernization of Screening Mammography Benefit," provides for new payment methodologies for both diagnostic and screening mammograms that utilize advanced new technologies for the period April 1, 2001, through December 31, 2001. 

Screening Pap Smears

Sections 1861(s)(14) and 1861(nn) of the Act, (as enacted by §6115 of the Omnibus Budget Reconciliation Act of 1989) provides for coverage of screening pap smears for services provided on or after July 1, 1990. Screening pap smears are laboratory tests consisting of a routine exfoliative cytology test (Papanicolaou test) provided for the purpose of early detection of cervical cancer. It includes a collection of the sample of cells and a physician's interpretation of the test.

Payment is made under the clinical diagnostic laboratory fee schedule.

 Screening Pelvic Examinations

Section 4102 of the BBA of 1997 (P.L. 105-33) amended §1861(nn) of the Act (42 USC 1395X(nn)) to include coverage of screening pelvic examinations for all female beneficiaries for services provided January 1, 1998, and later. Effective July 1, 2001, the Consolidated Appropriations Act of 2001 (P.L. 106-554) modifies §1861(nn) to provide Medicare coverage for biennial screening pelvic examinations.

Payment is made under the Medicare Physician's Fee Schedule (MPFS).

Prostate Cancer Screening

Sections 1861(s)(2)(P) and 1861(oo) of the Act (as added by §4103 of the Balanced Budget Act of 1997), provide for coverage of certain prostate cancer screening tests subject to certain coverage, frequency, and payment limitations. Effective for services furnished on or after January 1, 2000, Medicare covers prostate cancer screening tests/procedures for the early detection of prostate cancer. Coverage of prostate cancer screening tests includes the following procedures furnished to an individual for the early detection of prostate cancer:

• Screening digital rectal examination; and 

• Screening prostate specific antigen (PSA) blood test

Each test may be paid at a frequency of once every 12 months for men who have attained age 50 (i.e., starting at least one day after they have attained age 50), if at least 11 months have passed following the month in which the last Medicare-covered screening digital rectal examination was performed (for digital rectal exams) or PSA test was performed (for PSA tests).

Payment is made under the clinical diagnostic laboratory fee schedule.

Colorectal Cancer Screening

Effective for services furnished on or after January 1, 1998, payment may be made for colorectal cancer screening for the early detection of cancer. For screening colonoscopy services (one of the types of services included in this benefit) prior to July 2001, coverage was limited to high-risk individuals. For services July 1, 2001, and later, screening colonoscopies are covered for individuals not at high risk. Screening colonoscopies are not payable to the SNF. Screening colonoscopies are only covered when rendered in a hospital or CAH.

For all other colorectal screening services payment is made under the MPFS or the clinical diagnostic laboratory fee schedule based on the service rendered.