Preventive Services
This page is a central location for preventive services information, including CMS resources.
Spotlight
Educational Tool
The CMS website features the MLN Educational Tool MLN006559, Medicare Preventive Services, a comprehensive resource designed to provide useful information such as International Classification of Diseases 10th Revision (ICD-10) diagnosis codes, Healthcare Common Procedure Coding System (HCPCS) codes, Current Procedural Terminology (CPT) codes, frequency limitations, and Medicare coverage guidelines for each Medicare covered service.
Medicare covered preventive services include:
Policy Information
Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage.
LCDs
Learn more about the LCD development process through the following:
Search for preventive services-related LCDs using these available resources:
Medical Documentation
For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding, and billing requirements and substantiate the level of care billed. The following resources are specific to preventive services, but may not address all required medical documentation requirements:
- Medical Documentation Checklists
- Checklist: Annual Wellness Visit (AWV)
- MLN Educational Tool MLN006559, Medicare Preventive Services
- A Framework for Patient-Centered Health Risk Assessments: Providing Health Promotion and Disease Prevention Services to Medicare Beneficiaries
- MLN Booklet MLN904084, Screening, Brief Intervention & Referral to Treatment (SBIRT) Services
Claim Submission and Reimbursement
- Fee Schedules
- MLN Fact Sheet MLN909289, Advance Care Planning
- Medical Nutrition Therapy and Diabetes Self-Management Training Coverage and Billing Requirements
- Initial Preventive Physical Exam
- Annual Wellness Visit
- Modifiers
Additional Information
- View our FastTrack to Medicare Coverage Policies Tool to locate guidelines
- Pre-exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent Human Immunodeficiency Virus (HIV) Infection
- TPE: Part B Review Topics
CMS
- CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 280
- CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 18
- Preventive Services
- Cognitive Assessment & Care Plan Services
- 2025 Medicare Fee-for-Service Supplemental Improper Payment Data
Education
View our wide selection of free, live and on-demand training options:
Stay Informed
Stay updated on the latest Medicare information with free email subscriptions: