Screening and Counseling Services. Screenings and counseling services will provide coverage for evidence-based services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force (USPSTF) for individuals in certain age groups or based on risk factors. Key screenings include but are not limited to: • Abdominal aortic aneurism screening for men ages 65 to 75 years old with a history of smoking • Abdominal blood glucose and type 2 diabetes mellitus screening for adults ages 40 to 70 years old who are overweight or obese • Counseling for HIV, sexually transmitted infections and domestic violence and abuse • Falls prevention screening for adults age 65 and older • Hepatitis B screenings for persons at high risk of infection • Hepatitis C screenings for adults age 18 to 79 years old • Latent tuberculosis screening for high risk populations • Lung cancer screenings for ages 55 to 80 with a history of smoking • Preventive Physical Examinations • Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam • Periodic tests to determine metabolic, blood hemoglobin, blood pressure, blood glucose level, and blood cholesterol level, or alternatively, a fractionated cholesterol level including a Low-Density Lipoprotein (LDL) level and a High-Density Lipoprotein (HDL) level • Periodic stool examination for the presence of blood for all persons 40 years of age or older • One baseline mammogram to persons of age 35 through 39, one mammogram biennially to persons age 40 through 49, and one mammogram annually to persons age 50 and over • Colorectal cancer screening in accordance with the evidence-based recommendations established by the United States Preventive Services Task Force for determining the presence of pre-cancerous or cancerous conditions and other health problems including: o Fecal occult blood testing (FOBT) o Flexible Sigmoidoscopy o Colonoscopy, including anesthesia services and polyp removal when performed as a screening procedure. o Virtual Colonoscopy - Requires Prior Authorization o Double contrast barium enema • Smoking Cessation Program - Refer to Smoking Cessation Counseling/Program in this Section. • Screening to determine the need for vision and hearing correction • Syphilis infection screening in persons who are at an increased risk for infection and pregnant women • Preventive screening services including screening for depression, diabetes, cholesterol, obesity, various...
Screening and Counseling Services. Screenings and counseling services will provide coverage for evidence-based services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force for individuals in certain age groups or based on risk factors. Key screenings include but are not limited to: Abdominal aortic aneurism screening for men ages 65 to 75 years old who have ever smoked. Anxiety in Children and Adolescents: Screening ages 8 to 18 years old. Prediabetes and Type 2 diabetes mellitus screening for adults ages 35 to 70 years old who are overweight or obese. Screening for human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and domestic violence and abuse. Heart Artery Calcification scans are a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function. These scans are Covered for individuals between the ages of 45-65 years. Refer to the Heart Artery Calcification section for more details. Falls prevention screening for adults age 65 or older. Osteoporosis Coverage for services related to the treatment and appropriate management of osteoporosis when such services are determined to be Medically Necessary. Hepatitis B screenings for persons at high risk of infection. Hepatitis C screenings for adults ages 18 to 79 years old. Latent tuberculosis screening for high-risk populations. Lung cancer screenings for ages 50 to 80 years with a history of smoking. Preventive Physical Examinations. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication adults aged 40 to 75 years who have one or more cardiovascular risk factors. Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam. Periodic tests to determine metabolic, blood hemoglobin, blood pressure, blood glucose level, and blood cholesterol level, or alternatively, a fractionated cholesterol level including a low-density lipoprotein (LDL) level and a high-density lipoprotein (HDL) level. Periodic stool examination for the presence of blood for all persons 45-75 years of age. Colorectal cancer screening in accordance with the evidence-based recommendations established by the United States Preventive Services Task Force for determining the presence of pre-cancerous or cancerous conditions and other health problems including: o Fecal occult blood testing (FOBT) o Flexible sigmoidoscopy o Colonoscopy, and ...
