Common use of Prior Auth Required Clause in Contracts

Prior Auth Required. o Colonoscopy o Virtual Colonoscopy - Requires Prior Authorization o Double contrast barium enema Refer to  Smoking Cessation Program - Refer to Smoking Cessation Counseling/Program in this Section.  Screening to determine the need for vision and hearing correction  Periodic glaucoma eye test  Preventive screening services including screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and s xually transmitted infections, as well as counseling for drug and Tobacco use, healthy eating and other common health concerns.  Health education and consultation from In-network Practitioners/Providers to discuss lifestyle behaviors that promote health and well-being including, but not limited to, the consequence of Tobacco use, and/or smoking control, nutrition and diet recommenda ions, and exercise plans. For Members 19 years of age or older, health education also includes information related to lower back protection, immunization practices, breast self-examination, testicular self-examination, use of seat belts in motor vehicles and other preventive health care practices. Routine Immunizations Routine Immunization incl des Cover ge for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of:  The American Academy of Pediatrics  The Advisory Committee on Immunization Practices  The U.S. Preventive Services Task Force o Immunizations for routine use in children, adolescents, and adults that have, in effect, a recommendation from the Advisory Committee on Immunizations Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to the individual involved. o HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP). Childhood Preventive Health Services Childhood Preventive Health Services includes Coverage for Well-Child Care in accordance with the recommendations of the American Academy of Pediatrics.  With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes: o Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam school, or camp activities. or as required for participation in sports, o Hearing and Vision s reening for correction. This does not include routine eye exams Refer to or Eye Vision and Hearing screening to determine Refractions performed by eye care specialists. One Eye Refraction per Calendar Year is Covered for children under age six when Medically Necessary to aid in the diagnosis of certain eye diseases. o Pediatric Vision – Please refer to Exhibit A at the end of this Agreement for benefit coverage and details.

Prior Auth Required. o Colonoscopy o Virtual Colonoscopy - Requires Prior Authorization o Double contrast barium enema Refer to  • Smoking Cessation Program - Refer to Smoking Cessation Counseling/Program in this Section.  • Screening to determine the need for vision and hearing correction  • Periodic glaucoma eye test  • Preventive screening services including screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and s xually transmitted infections, as well as counseling for drug and Tobacco use, healthy eating and other common health concerns.  • Health education and consultation from In-network Practitioners/Providers to discuss lifestyle behaviors that promote health and well-being including, but not limited to, the consequence of Tobacco use, and/or smoking control, nutrition and diet recommenda ions, and exercise plans. For Members 19 years of age or older, health education also includes information related to lower back protection, immunization practices, breast self-examination, testicular self-examination, use of seat belts in motor vehicles and other preventive health care practices. Routine Immunizations Routine Immunization incl des Cover ge for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of:  • The American Academy of Pediatrics  • The Advisory Committee on Immunization Practices  • The U.S. Preventive Services Task Force o Immunizations for routine use in children, adolescents, and adults that have, in effect, a recommendation from the Advisory Committee on Immunizations Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to the individual involved. o HPV Vaccine coverage for the Human Papillomavirus as approved by the United States Food and Drug Administration (FDA) and in accordance with all applicable federal and state requirements and the guidelines established by the Advisory Committee on Immunization Practices (ACIP). Childhood Preventive Health Services Childhood Preventive Health Services includes Coverage for Well-Child Care in accordance with the recommendations of the American Academy of Pediatrics.  • With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Key preventive care includes: o Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam school, or camp activities. or as required for participation in sports, o Hearing and Vision s reening for correction. This does not include routine eye exams Refer to or Eye Vision and Hearing screening to determine Refractions performed by eye care specialists. One Eye Refraction per Calendar Year is Covered for children under age six when Medically Necessary to aid in the diagnosis of certain eye diseases. o Pediatric Vision – Please refer to Exhibit A at the end of this Agreement for benefit coverage and details.