Monday, August 1, 2022

Medicare Defines Diagnostic

 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf


20.4.1 Diagnostic Service Defined

20.4.1 - Diagnostic Services Defined (Rev. 82; Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08) 

A service is “diagnostic” if it is an examination or procedure to which the patient is subjected, or which is performed on materials derived from a hospital outpatient, to obtain information to aid in the assessment of a medical condition or the identification of a disease. Among these examinations and tests are diagnostic laboratory services such as hematology and chemistry, diagnostic x-rays, isotope studies, EKGs, pulmonary function studies, thyroid function tests, psychological tests, and other tests given to determine the nature and severity of an ailment or injury.


410.2 PREV defined   42 cfr 410.2   - defined only by examples list, not by theory.





Could CMS's list of PREV services be segregated into logical and insightful categories?  EG GLAUCOMA and BMM are really "management of disease".  GLAUCOMA is left out of UPSTF, and USPSTF handles BMM very differently.


Inbtriguing phrase "screening, and other preventive services"  (E.g. OCP's are not screening, baby aspirin is not screening)


Wich are TESTS and which are nOT

ssa 1861

(ww)(1) The term “initial preventive physical examination” means physicians’services consisting of a physical examination (including measurement of height, weight, body mass index, and blood pressure) with the goal of health promotion and disease detection and includes education, counseling, and referral with respect to screening and other preventive services described in paragraph (2), end-of-life planning (as defined in paragraph (3)) upon the agreement with the individual, and the furnishing of a review of any current opioid prescriptions (as defined in paragraph (4)), but does not include clinical laboratory tests.[533]

(2) The screening and other preventive services described in this paragraph include the following:

(A) Pneumococcal, influenza, and hepatitis B vaccine and administration under subsection (s)(10).

(B) Screening mammography as defined in subsection (jj).

(C) Screening pap smear and screening pelvic exam as defined in subsection (nn).

(D) Prostate cancer screening tests as defined in subsection (oo).

(E) Colorectal cancer screening tests as defined in subsection (pp).

(F) Diabetes outpatient self-management training services as defined in subsection (qq)(1).

(G) Bone mass measurement as defined in subsection (rr).

(H) Screening for glaucoma as defined in subsection (uu).

(I) Medical nutrition therapy services as defined in subsection (vv).

(J) Cardiovascular screening blood tests as defined in subsection (xx)(1).

(K) Diabetes screening tests as defined in subsection (yy).

(L) Ultrasound screening for abdominal aortic aneurysm as defined in section 1861(bbb).

(M) An electrocardiogram.

(N) Screening for potential substance use disorders.[534]

(O) Additional preventive services (as defined in subsection (ddd)(1)).


CONTINUE AS DDD BUT LIST NCDS FOR PREVENTIVE SINCE 2008






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