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 with a history of smoking. • Prediabetes and Type 2 diabetes mellitus screening for adults ages 35 to 70 years old who are overweight or obese. • Counseling 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. • 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. • 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 years of age or older. • One mammogram every two years to persons age 40 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, and polyp removal when performed as a screening ▪ anesthesia services are also at no Cost-Share to Covered members when performed as part of Colonoscopy screening o Virtual colonoscopy – requires Prior Authorization o Double contrast barium enema • Smoking Cessation Program – refer to Smoking Cessation Counseling...
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: • 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 • 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 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 • Periodic glaucoma eye test • Preventive screening services including screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and sexually transmitted infections, as well as counseling for drug and Tobacco use, healthy eating and other common health concerns. • Health education and consultation from Practitioners/Providers to discuss lifestyle behaviors that promote health and well-being including, but not limited to, the consequences of Tobacco use, and/or smoking control, nutrition and diet recommendations, 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 includes Coverage 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 ...
