Which laboratory tests are covered by Medicare for annual wellness visits?

From the Guidelines

Medicare covers annual wellness visits, which include certain lab tests.

Covered Laboratory Tests

The covered labs for annual wellness visits are:

• Lipid panel (every 5 years)
• Blood glucose test (for patients with risk factors for diabetes)
• Colorectal cancer screening (for patients 50-75 years old)
• Mammogram (for women 40-74 years old, every 2 years)
• Pap test and pelvic exam (for women 21-65 years old, every 3 years)
• Prostate-specific antigen (PSA) test (for men 50-74 years old, every year)
• Bone mass measurement (for women 65 and older, and for men with risk factors for osteoporosis) as stated in various guidelines 1. Additionally, Medicare covers other preventive services, such as vaccinations, including influenza, pneumococcal, and hepatitis B vaccines, as well as screenings for depression, alcohol misuse, and cognitive impairment 1. It's essential to note that these services are covered only when provided by a healthcare provider who participates in Medicare.

From the Research

Laboratory Tests Covered by Medicare for Annual Wellness Visits

The provided studies do not explicitly list the laboratory tests covered by Medicare for annual wellness visits. However, the following points can be inferred:

• The Medicare Annual Wellness Visit is an annual preventive health benefit that provides an opportunity for clinicians to review preventive health recommendations and screen for geriatric syndromes 2.
• The visit includes detection of cognitive impairment, which may involve structured cognitive assessments 3.
• The Centers for Medicare and Medicaid Services (CMS) has set requirements for the Medicare Annual Wellness Visit, but the specific laboratory tests covered are not mentioned in the provided studies 4.
• The studies focus on the adoption, value, and utilization of the Medicare Annual Wellness Visit, as well as the variability in assessments and tools used during the visit 5, 4, 6.

Key Findings

• Approximately one-half of Medicare beneficiaries surveyed reported having an annual wellness visit, and fewer than one-third reported having a structured cognitive assessment 3.
• Medicare Advantage enrollees were more likely to report having an annual wellness visit and a structured cognitive assessment compared to fee-for-service enrollees 3.
• Primary care providers with the highest acuity patients had lower AWV utilization rates, and utilization rates were lower in rural counties 6.