[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR410.19]

[Page 329]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 410_SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS--Table of 
Contents
 
               Subpart B_Medical and Other Health Services
 
Sec.  410.19  Ultrasound screening for abdominal aortic aneurysms: 
Condition for and limitation on coverage.

    (a) Definitions: As used in this section, the following definitions 
apply:
    Eligible beneficiary means an individual who--
    (1) Has received a referral for an ultrasound screening for an 
abdominal aortic aneurysm as a result of an initial preventive physical 
examination (as defined in section 1861(ww)(1) of the Act);
    (2) Has not been previously furnished an ultrasound screening for an 
abdominal aortic aneurysm under Medicare program; and
    (3) Is included in at least one of the following risk categories:
    (i) Has a family history of an abdominal aortic aneurysm.
    (ii) Is a man age 65 to 75 who has smoked at least 100 cigarettes in 
his lifetime.
    (iii) Is an individual who manifests other risk factors in a 
beneficiary category recommended for screening by the United States 
Preventive Services Task Force regarding abdominal aortic aneurysms, as 
specified by the Secretary through a national coverage determination 
process.
    Ultrasound screening for abdominal aortic aneurysms means the 
following services furnished to an asymptomatic individual for the early 
detection of an abdominal aortic aneurysm:
    (1) A procedure using soundwaves (or other procedures using 
alternative technologies of commensurate accuracy and cost, as specified 
by the Secretary through a national coverage determination process) 
provided for the early detection of abdominal aortic aneurysms.
    (2) Includes a physician's interpretation of the results of the 
procedure.
    (b) Conditions for coverage of an ultrasound screening for abdominal 
aortic aneurysms. Medicare Part B pays for one ultrasound screening for 
an abdominal aortic aneurysm provided to eligible beneficiaries, as 
described in this section, after a referral from a physician or a 
qualified nonphysician practitioner as defined in Sec.  410.16(a), when 
the test is performed by a provider or supplier that is authorized to 
provide covered ultrasound diagnostic services.
    (c) Limitation on coverage of ultrasound screening for abdominal 
aortic aneurysms. Payment may not be made for an ultrasound screening 
for an abdominal aortic aneurysm that is performed for an individual 
that does not meet the definition of ``eligible beneficiary'' specified 
in this section.

[71 FR 69783, Dec. 1, 2006]