Medicare to reimburse preventive cholesterol screening

Nov 9 2004

As the nation's leading cardiologists gather for the American Heart Association's Scientific Sessions 2004, the Centers for Medicare & Medicaid Service (CMS) has announced the 2005 Physician Fee Schedule, which guarantees access to preventive cholesterol screenings for 39 million Medicare-eligible beneficiaries.

According to Cholestech, this will significantly improve the quality of cardiac healthcare for seniors.

"Cardiovascular disease is the number one killer of both men and women, making cholesterol screening vitally important to identify individuals at risk because treatment is proven to saves lives," said Lori Mosca, MD, PhD, director of preventive cardiology at New-York Presbyterian Hospital and associate professor of medicine at Columbia University Medical Center. "Providing access to preventive screening to seniors, the segment of the population most likely to develop heart problems, can potentially have a huge impact on the burden of cardiovascular disease and reducing health care costs. Particularly among seniors, we can't afford to wait for cardiovascular disease to manifest as more than 40 percent of patients die from an initial heart attack."

Nearly 800,000 seniors die from cardiovascular disease annually, representing 84 percent of total number of cardiovascular deaths in the United States. Further, it is estimated that 25 to 29 million Medicare-eligible seniors suffer from either coronary heart disease (CHD) or hardening of the arteries. The National Cholesterol Education Program, developed by the National Institutes of Health (NIH), recommends that more than 200 million Americans need to be screened for cholesterol annually.

Beginning in January of 2005, Medicare Section 612 -- Cardiovascular Screening coverage goes into effect as part of the larger Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). All Medicare beneficiaries will have access to preventive cholesterol screening blood tests for the early detection of cardiovascular disease and all new Medicare members will be covered for an initial physical examination. Both include the use of three tests to detect early risk for cardiovascular disease, including total cholesterol, a HDL-cholesterol, and a triglycerides test, which can be ordered as a lipid panel or individually.

Until enactment of this bill, Medicare beneficiaries were only covered for cholesterol tests if they suffered from diagnosed illnesses such as heart disease, stroke, diabetes or other disorders associated with elevated cholesterol levels. In many cases, eligible seniors were already victims of one or more conditions that cholesterol screening might have caught and treatment may have prevented.