Medicare Policies
To all our Medicare Patients:
Please be advised of the following Medicare policies:
Medicare does not cover preventative services. When you are seen for your Annual Exam, the following services are provided:
- Office Visit - $146.52 this charge includes our staff checking your weight, and blood pressure, as well as the doctor discussing any health concerns or changes in your overall health. Dispensing maintenance prescriptions and refills are also a part of the office charge.
- Collection of Pap smear - $46.54 (There is a separate lab charge for processing of specimen - this is billed by the lab)
- Breast Exam - $40.78
- Hemoccult - $15.00
- Urine Dip - $8.00
Though the breast exam and papsmear will be covered every 24 months (two years), the office visit charge that is assessed when you are seen will never be paid by Medicare. The hemoccult is covered every 12 months (one year).
You may choose to see your Primary Care Physician for your routine annual exam and your Gynecologist for all other female issues, or you may choose to see your Gynecologist for the annual exam. Please be aware that when you choose to see a specialist (your Gynecologist) for your annual well-woman exam, the office visit charge will not be paid by Medicare. The fee for that service, $146.52, will be your responsibility. Should you be seen for services that are not routine, such as an acute problem, at the same time that your annual breast exam and papsmear are done, the office visit will be billed to Medicare and may be covered. The breast exam and papsmear may or may not be covered depending on whether or not it has been 12 or 24 months since your last breast exam and Pap smear. It is your (the patient’s) responsibility to keep track of what year Medicare last covered those services. We will be happy to bill for those charges and wait for Medicare’s reply. You will be billed for any services that Medicare does not cover.
Should you have any questions regarding Medicare’s payment policies for preventative services, please contact Medicare. If needed, we would be happy to explain this policy to you at your next appointment.
Thank you.
Type of visit |
How often? |
Covered by
|
What is the cost to ME? |
|
Routine well-woman annual Exam |
…with your Primary Care Physician | Once per year | Yes | $0 |
| OR …with your specialist (Gynecologist) |
Any time | No | $146.52 | |
| OR …if you go to your specialist, but also have an immediate problem |
Once per year | Yes | $0 | |
Pap Smear |
Annual or General office visit |
Once every two years | Yes | $0 |
| More than once every two years | No | $46.54 (There is also a separate lab charge for processing of specimen which is billed by the lab) | ||
Breast Exam |
Annual or General office visit |
Once every two years | Yes | $0 |
| More than once every two years/td> | No | $40.78 | ||
Hemoccult |
Annual or General office visit |
Once per year | Yes | $0 |
| More than once per year | No | $15.00 | ||
| Urine Dip | Annual or General office visit | Any time | No | $8.00 |
| Acute Problem (injury, etc.) | Annual or General office visit office visit | Any time | Maybe | Determined by Medicare |