Page 272 - Medicare Benefit Policy Manual

Eligible beneficiary: An individual who is no longer within 12 months after the effective
date of his/her first Medicare Part B coverage period and who has not received either an
IPPE or an AWV providing PPPS within the past 12 months.

Establishment of, or an update to, the individual’s medical/family history: At a
minimum, the collection and documentation of the following:

a. Past medical and surgical history, including experiences with illnesses, hospital
stays, operations, allergies, injuries, and treatments.

b. Use or exposure to medications and supplements, including calcium and
vitamins.

c. Medical events in the beneficiary’s parents and any siblings and children,
including diseases that may be hereditary or place the individual at increased risk.

First AWV providing PPPS: The provision of the following services to an eligible
beneficiary by a health professional that include, and take into account the results of, a
health risk assessment as those terms are defined in this section:

a. Review (and administration if needed) of a health risk assessment (as defined
in this section).

b. Establishment of an individual’s medical/family history.

c. Establishment of a list of current providers and suppliers that are regularly
involved in providing medical care to the individual.

d. Measurement of an individual’s height, weight, BMI (or waist circumference,
if appropriate), BP, and other routine measurements as deemed appropriate, based
on the beneficiary’s medical/family history.

e. Detection of any cognitive impairment that the individual may have as defined
in this section.

f. Review of the individual’s potential (risk factors) for depression, including
current or past experiences with depression or other mood disorders, based on the
use of an appropriate screening instrument for persons without a current diagnosis
of depression, which the health professional may select from various available
standardized screening tests designed for this purpose and recognized by national
medical professional organizations.

g. Review of the individual’s functional ability and level of safety based on direct
observation, or the use of appropriate screening questions or a screening
questionnaire, which the health professional may select from various available