The US Preventive Services Task Force (USPSTF) recently updated their recommendations1 and evidence report and systematic review2 regarding screening for abdominal aortic aneurysm (AAA), which will be published in JAMA on December 10, 2019. They are largely unchanged from the prior recommendations published in 2014. The USPSTF again recommends that men aged 65 to 75 who have ever smoked should undergo a 1-time ultrasonographic screening for AAA (B recommendation). For men aged 65 to 75 years who have never smoked, the USPSTF does not recommend routine screening. Instead, they recommend selectively screening men in this age group, taking into account the medical history, family history, other risk factors, and personal values. They assign a C recommendation to this group. They recommend against screening women who have never smoked with no family history and assign a D recommendation (not recommended). For women aged 65 to 75 years who have ever smoked or have a family history of AAA, they state that the current evidence is insufficient to assess the balance of benefits and harms (I statement; insufficient evidence to make a recommendation). The recommendation and letter grade is important, as the Patient Protection and Affordable Care Act mandates that private insurers cover services that receive a grade of A or B by the USPSTF. Thus, the US Centers for Medicare & Medicaid Services (CMS) and private insurance must cover screening for men aged 65 to 75 years who ever smoked. However, although the USPSTF does recommend selected screening for men aged 65 to 75 years without a smoking history but with other risk factors for AAA, this may not be covered by private insurance owing to the C recommendation. The Centers for Medicare & Medicaid Services cannot reimburse interventions with a D recommendation but can selectively do so for C recommendations and I statements. Although theoretically possible, very few C recommendations or I statements interventions end up reimbursed under CMS.
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Schermerhorn M. Updated US Preventive Services Task Force Recommendations for Abdominal Aortic Aneurysm—Are We Really Up To Date? JAMA Surg. Published online December 10, 2019. doi:10.1001/jamasurg.2019.5234
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