Procedures we cover

Screening Mammography (Bilateral)

Annual or biennial screening mammogram for breast cancer detection. Recommended for women starting at 40-50 depending on guideline body, continuing through age 74.

CPT 77067·BreastCMS shoppable

Diagnostic Mammography (Unilateral)

Targeted diagnostic mammogram of one breast, performed when a screening mammogram or symptom warrants closer evaluation.

CPT 77065·Breast

Low-Dose CT for Lung Cancer Screening

Low-dose chest CT for adults 50-80 with significant smoking history. Annual screening reduces lung cancer mortality and is covered with no cost-sharing under Medicare and most insurers.

CPT 71271·Lung

Colonoscopy, Diagnostic

Diagnostic colonoscopy to examine the colon for polyps, bleeding, or other findings. Often follows an abnormal stool test or symptoms.

CPT 45378·ColorectalCMS shoppable

PSA (Prostate-Specific Antigen) Test

Blood test measuring prostate-specific antigen, used as an early indicator for prostate cancer in men 50+ (or earlier with risk factors).

CPT 84153·ProstateCMS shoppable

Flexible Sigmoidoscopy

Examination of the lower colon (sigmoid) — a less-extensive alternative to full colonoscopy, sometimes paired with stool testing.

CPT 45330·Colorectal

Echocardiogram, Complete with Doppler

Comprehensive heart ultrasound with Doppler flow analysis. Evaluates heart-valve disease, heart failure, and structural abnormalities.

CPT 93306·Echocardiography

ECG, Resting 12-Lead with Interpretation

Standard resting electrocardiogram with interpretation. Used routinely to screen for arrhythmia and ischemia.

CPT 93000·Electrocardiography

Cardiac Stress Test (Treadmill, with ECG)

Exercise treadmill stress test with continuous ECG monitoring. Evaluates exercise-induced symptoms and ischemia.

CPT 93015·Stress Testing

Holter Monitor (24–48 hour Continuous ECG)

Wearable continuous ECG monitor worn for 24-48 hours to capture intermittent arrhythmias not seen on a resting ECG.

CPT 93224·Ambulatory Monitoring

Cardiac Catheterization, Left Heart with Coronary Angiography

Diagnostic catheterization of the left heart with coronary angiography. Performed to evaluate chest pain, possible coronary artery disease, and pre-procedure planning.

CPT 93458·Cath Lab

Emergency Department Visit, Moderate Severity

Emergency department evaluation and management of moderate severity (Level 4). The most-common ED level for adults with significant non-life-threatening symptoms.

CPT 99284·ED Visit

Emergency Department Visit, High Severity

Emergency department evaluation and management of high severity (Level 5). For complex or unstable presentations.

CPT 99285·ED Visit

Upper GI Endoscopy (EGD)

Esophagogastroduodenoscopy — flexible scope of the esophagus, stomach, and upper duodenum. Used for reflux, ulcers, bleeding, and surveillance.

CPT 43235·Upper GI

MRI of the Knee, Without Contrast

MRI of the knee without injected dye, used to evaluate joint pain, ligament tears, meniscal injury, and other soft-tissue conditions.

CPT 73721·MRI

MRI of the Brain, With and Without Contrast

Brain MRI with and without injected gadolinium contrast. Used to evaluate stroke, tumour, multiple sclerosis, and other neurological conditions.

CPT 70553·MRI

MRI of the Lumbar Spine, Without Contrast

MRI of the lower back to evaluate disc herniation, stenosis, and nerve compression — a frequent imaging study in adults with chronic back pain.

CPT 72148·MRI

MRI of the Shoulder, Without Contrast

Shoulder MRI used to evaluate rotator cuff tears, labral injuries, and chronic shoulder pain.

CPT 73221·MRI

CT Scan of the Chest, Without Contrast

CT scan of the chest, used to evaluate lung nodules, persistent cough, and other chest cavity conditions.

CPT 71250·CT

CT Abdomen and Pelvis, With Contrast

Combined CT of the abdomen and pelvis with IV contrast, used to evaluate abdominal pain, possible cancer, and many emergency presentations.

CPT 74177·CTCMS shoppable

CT Head, Without Contrast

Non-contrast head CT, the workhorse imaging study for stroke, head injury, and acute neurological symptoms.

CPT 70450·CT

Ultrasound of the Abdomen, Complete

Complete abdominal ultrasound to evaluate the liver, gallbladder, kidneys, pancreas, and major vessels.

CPT 76700·UltrasoundCMS shoppable

DEXA Scan (Bone Density)

Dual-energy X-ray absorptiometry to measure bone mineral density. Recommended for women 65+ and men 70+ to screen for osteoporosis.

CPT 77080·Bone Density

Chest X-Ray, Two Views

Standard two-view chest X-ray. The most common imaging study for pneumonia, congestive heart failure, and pre-operative clearance.

CPT 71046·X-Ray

Heart Failure & Shock With Major Complication

Inpatient admission for decompensated heart failure with major complication or comorbidity — one of the most common Medicare admissions.

MS-DRG 291·Cardiology

Septicemia or Severe Sepsis Without Mechanical Ventilation 96+ Hours, with MCC

Inpatient admission for septicemia or severe sepsis (without prolonged ventilation), with major complication. A leading admission code by volume.

MS-DRG 871·Infectious Disease

Chronic Obstructive Pulmonary Disease With MCC

Inpatient admission for COPD exacerbation with major complication or comorbidity — common in adults 65+ with smoking history.

MS-DRG 190·Pulmonology

Major Joint Replacement of Lower Extremity Without MCC

Inpatient stay for elective hip or knee replacement without major complication or comorbidity. The most common inpatient procedure in adults 65+.

MS-DRG 470·OrthopedicsCMS shoppable

Comprehensive Metabolic Panel

14-marker blood panel covering kidney function, liver function, electrolytes, and glucose. A core part of routine annual physicals.

CPT 80053·Blood ChemistryCMS shoppable

Complete Blood Count (CBC) with Automated Differential

Measures red cells, white cells, platelets, and a differential of white-cell types. Screens for anemia, infection, and blood disorders.

CPT 85025·HematologyCMS shoppable

Lipid Panel

Measures total cholesterol, HDL, LDL, and triglycerides. Cornerstone of cardiovascular-risk screening.

CPT 80061·Blood Chemistry

Hemoglobin A1c (HbA1c)

Three-month average of blood glucose. Used to diagnose diabetes/prediabetes and monitor diabetes control.

CPT 83036·Endocrinology

Thyroid-Stimulating Hormone (TSH)

First-line thyroid-function test, screening for hypothyroidism and hyperthyroidism.

CPT 84443·Endocrinology

Vitamin D, 25-Hydroxy

Measures circulating vitamin D, increasingly tested in adults 50+ for bone-health and general-wellness reasons.

CPT 82306·Blood Chemistry

Urinalysis, Automated, Without Microscopy

Routine automated dipstick urinalysis used to screen for kidney issues, infection, and diabetes-related changes.

CPT 81003·Renal

BNP (Natriuretic Peptide)

Blood biomarker for heart failure. Used in emergency departments to evaluate shortness of breath and in ongoing heart-failure management.

CPT 83880·Cardiac

Psychiatric Diagnostic Evaluation

Comprehensive initial psychiatric evaluation by a licensed mental-health clinician. Covers diagnostic interview without medical services.

CPT 90791·Diagnostic Eval

Cataract Surgery, Single Eye

Removal of a cataract with insertion of an intraocular lens (IOL). One of the most common procedures in adults 65+.

CPT 66984·OphthalmologyCMS shoppable

Carpal Tunnel Release

Open or endoscopic release of the transverse carpal ligament to relieve median-nerve compression at the wrist.

CPT 64721·Hand Surgery

Inguinal Hernia Repair (Open)

Open repair of an inguinal hernia in adults. Common in men 50+; performed laparoscopically as an alternative coded separately.

CPT 49505·General Surgery

Skin Lesion Excision (Benign, Trunk/Arms/Legs ≤0.5 cm)

Surgical removal of a small benign skin lesion. Frequently performed in office or clinic settings, common in adults 50+ for moles and pre-cancers.

CPT 11400·Dermatology

Polysomnography (Attended Sleep Study, 4+ Channels)

Attended overnight sleep study to diagnose sleep apnea and other sleep disorders. Common diagnostic step before CPAP therapy.

CPT 95810·Sleep Study

Physical Therapy Evaluation, Low Complexity

Initial physical therapy evaluation, low complexity. Frequently the entry point for outpatient PT after orthopedic surgery, falls, or chronic pain.

CPT 97161·Physical Therapy

Shingrix (Shingles Vaccine)

Two-dose recombinant zoster vaccine to prevent shingles. The CDC recommends Shingrix for adults 50 and older, including those previously vaccinated with Zostavax.

CPT 90750·Preventive

Pneumovax 23 (PPSV23 Pneumococcal)

23-valent pneumococcal polysaccharide vaccine recommended for adults 65 and older, and earlier for those with chronic conditions.

CPT 90732·Preventive

Prevnar 20 (PCV20 Pneumococcal Conjugate)

20-valent pneumococcal conjugate vaccine, the broader-coverage option for adults 65+ alongside or instead of PPSV23.

CPT 90671·Preventive

Influenza Vaccine, Quadrivalent (Flu Shot)

Annual quadrivalent flu vaccine for adults. CDC recommends for everyone 6 months and older, with high-dose variants for adults 65+.

CPT 90686·Seasonal

RSV Vaccine (Abrysvo / Arexvy)

Respiratory syncytial virus vaccine, recommended as a one-time dose for adults 60 and older to reduce risk of severe lower-respiratory illness.

CPT 90679·Preventive

Tdap Booster (Tetanus, Diphtheria, Pertussis)

Combined tetanus, diphtheria, and pertussis booster. Recommended every 10 years for adults, with at least one Tdap-containing dose in adulthood.

CPT 90715·Preventive

Comprehensive Eye Exam, Established Patient

Comprehensive ophthalmologic exam for an established patient, including refraction. Recommended every 1-2 years for adults 50+ to screen for cataracts and glaucoma.

CPT 92014·Eye Exam