Preventive Guidelines 2024

NOTICE: The preventive guidelines displayed below are intended as a billing resource for providers. Benefits and services are subject to change by Alliant. To understand if you or your patient qualifies for these benefits, refer to the Member’s Certificate of Coverage or call Client Services at (800) 811-4793.

As new recommendations and guidelines for preventive care are published by the government sources identified above, they will become covered under the member’s Contract for plan years which begin one year after the date the recommendation or guideline is issued or on such other date as required by the Affordable Care Act. The plan year, also known as a policy year for the purposes of this provision, is based on the calendar year.

Preventive Health Care BenefitFrequencyAge LimitsICD 10 CodesCPT/HCPCSOther Requirement(s)
1Abdominal Aortic Aneurysm Screening
USPSTF Rating B with Final Evidence Review 12/10/2019 The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
1 per lifetimeMen Ages 65-75Group 376706N/A
5Prediabetes and Type 2 Diabetes: Screening
USPSTF Rating B with Final Evidence Review 08/24/2021 The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions.
1 per year Adults
1 per year Pregnant
Ages 40 to 70 unless pregnant then no age limitAllow with any diagnosis82947, 82948, 82950, 82951, 82952, 83036 0403T, 0488T N/A
21Unhealthy Drug Use: Screening
USPSTF Rating B with Final Evidence Review 06/09/2020 The USPSTF recommends screening by asking questions about unhealthy drug use in adults age 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.)
1 per year18 years and upAllow with any diagnosis99408, 99409, G0396, G0397, G2011N/A
21

Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions
USPSTF Rating B with Final Evidence Review 11/13/2018 The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.

1 per yearNoneGroup 899408, 99409, G0442, G0443, G0396, G0397N/A
1Anemia Screening
Bright Futures recommends anemia screening from infancy through 21 years of age.
NoneAges prenatal to age 21Group 180055, 85013, 85014, 85018, 85025, 85027 or 80081N/A
1Anxiety Disorders in Adults: Screening
USPSTF Rating B with Final Evidence Review 06/20/23 The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons.
1 per year and
1 per year pregnant
NoneGroup 1
Group 2
Group 15
96127N/A
1Anxiety in Children and Adolescents: Screening
USPSTF Rating B with Final Evidence Review 10/04/2022 The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years.
1 per yearNoneGroup 1
Group 2
Group 15
96127N/A
1Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality:
Preventive Medication The USPSTF recommends the use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons who are at high risk for preeclampsia.
Pharmacotherapy is administered through the Pharmacy Benefit - information is available on the Formulary Lookup Tool.Pharmacotherapy is administered through the Pharmacy Benefit - information is available on the Formulary Lookup Tool.OTC Aspirin (81 mg) is dispensed to member with a physician order at a participating pharmacy with no cost-sharing.
2

Bacteriuria Screening: Using urine culture in pregnant persons.
USPSTF Rating B with Final Evidence Review 09/24/2019 The USPSTF recommends screening for asymptomatic bacteriuria using urine culture in pregnant persons.

1 per year PregnantNoneGroup 1587081, 87084, 87086 or 87088N/A
2

Bilirubin Screening

Bright Futures recommends Newborn Bilirubin screening

1 per lifetimeAges 0 - 8 DaysGroup 182247, 88720Service is typically performed in the birth facility or as part of a wellness office visit.
2BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing
USPSTF Rating B with Final Evidence Review 08/20/2019 The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.
Annual coverage for Genetic Counseling and Evaluation and Management. One BRCA genetic testing evaluation per lifetime.NoneNo specific diagnosis code requiredGenetic Counseling 96040, S0265, Evaluation and Management 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99417, 99385, 99386, 99387, 99395, 99396, 99397, G0463 *BRCA genetic testing 81212, 81215, 81216, 81217, 81162, 81163, 81164, 81165, 81166, 81167 *Note genetic testing requires prior authorization. N/A
2Breast Cancer: Medication Use to Reduce Risk
USPSTF Rating B with Final Evidence Review 09/03/2019 USPSTF Population: Women at increased risk for breast cancer aged 35 years or older. The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.
1 per year for visit. No limit of fills on risk-reducing medications dispensed to member with a physician order with no cost-sharing35 years or olderGroup 999202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, 99397, 99417, G0463, 99401-99402 or is also included in wellness visit 99385-99387, 99395-99397N/A
3Chlamydial Infection Screening
USPSTF Rating B with Final Evidence Review 09/14/2021 The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection.
1 per year and 1 per year pregnantNoneGroup 136415, 36416, 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87801, 87810N/A
4Dyslipedemia Screening
Bright Futures recommends risk assessment to be performed with appropriate action to follow, if positive at ages 24 month, 4 years, 6 years, 8 years, 12 years, 13, years, 14 years, 15 years, 16 years. Bright Futures recommends testing be performed between ages 9 years-11 years, and again ages 17 years-21 years.
1 per yearNewborn through 21 years of ageGroup 180061, 82465 or 83718, 83719, 83721, 83722, 84478, 36415, 36416N/A
3Colorectal Cancer Screening - Sigmoidoscopy
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per 5 years unless high risk in which case is 1 per 2 yearsAges 45 - 75 unless high risk in which case is ages 18-75Group 13
Group 14
45330, 45331, 45333, 45334, 45335, 45338, 45346, G0104N/A
3Colorectal Cancer Screening - Colonoscopy
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per 10 years unless high risk in which case is 1 per 2 yearsAges 45 - 75 unless high risk in which case is ages 18-75Group 13
Group 14
45378, 45380, 45381, 45382, 45384, 45385, 45388, S0285, G0105, G0121N/A
6Fecal DNA (Cologuard)
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per 3 yearsAges 45 - 75Group 13 81528N/A
6Fecal Occult Blood Test (FOBT)
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per yearAges 45 - 75 unless high risk in which case is ages 18-75Group 13
Group 14
82270N/A
6Fecal Immunochemical Test (FIT)
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per yearAges 45 - 75 unless high risk in which case is ages 18-75Group 13
Group 14
82274N/A
3Colorectal Cancer Screening - Computed Tomography (CT) Colonography
USPSTF Rating A with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. USPSTF Rating B with Final Evidence Review 05/18/2021 The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
1 per 5 yearsAges 45 - 75 unless high risk in which case is ages 18-75Group 13
Group 14
74263Prior Authorization Required.
4Depression and Suicide Risk in Adults: Screening
USPSTF Rating B with Final Evidence Review 06/20/2023 The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults. Note Bright Futures recommends Maternal Depression Screening postpartum with well-child visits by 1 month, 2 months, 4 months, and 6 months of age.
No LimitAges 12 years and aboveGroup 1
Group 2
96127, 96161, G0444N/A
4Depression and Suicide Risk in Children and Adolescents: Screening
USPSTF Rating B with Final Evidence Review 10/11/2022 The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Note Bright Futures recommends Maternal Depression Screening postpartum with well-child visits by 1 month, 2 months, 4 months, and 6 months of age. Note Bright Futures Periodicity Schedule recommends depression and suicide screening at age 12-21 years.
No LimitAges 12 years and aboveGroup 1
Group 2
96127, 96161, G0444N/A
16Perinatal Depression: Preventive Interventions
USPSTF Rating B with Final Evidence Review 02/12/2019 The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions.
No LimitNoneGroup 1
Group 2
99401, 99402, 99403, 99404, 99411, 99412, 59425, 59426, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397N/A
5Emotional/Social/Behavioral Screening
Bright Futures recommends Behavioral/Social/Emotional Screening from age Newborn through 21 years of age.
No LimitNewborn through 21 years of ageGroup 1
Group 2
G0451, 96110, 96127, S0302 N/A
4Developmental Screening
Bright Futures recommends Developmental Screening at ages 9 months, 18 months and 30 months.
No LimitUp to age 3 yearsGroup 1
Group 2
96110N/A
4Developmental Surveillance
Bright Futures recommends Developmental Surveillance from age from age Newborn through 21 years of age.
See Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examN/A
1Autism Spectrum Disorder Screening
Bright Futures recommends Autism Spectrum Disorder Screening at ages 18 months and 24 months
NoneUp to age 24 months or 2 yearsGroup 1
Group 2
96110N/A
20Tobacco, Alcohol, or Drug Use Assessment
Bright Futures recommends Tobacco, Alcohol, or Drug Use risk assessment from ages 11 through 21 year years old.
1 AnnuallyAges 11-21 years of ageGroup 1
Group 2
99401, 99402, 99403, 99404, 99406, 99407, 99408, 99409, G0442, G0443, G0396, G0397, G2011N/A
6Falls Prevention in Community-Dwelling Older Adults: Interventions
USPSTF Rating B with Final Evidence Review 04/17/2018 The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.
3 annual - any combination Ages 65 and OlderGroup 497110, 97112, 97116, 97530, G0151, G0157, G0159, S9131 and S9476.N/A
6Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication
USPSTF Rating B with Final Evidence Review 08/01/2023 The USPSTF recommends that all persons planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid.
Not applicable, administered through PharmacyN/AOTC folic acid supplements are dispensed to member with a physician order with no cost-sharing.
16Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions USPSTF Rating B with Final Evidence Review 12/07/2021 The USPSTF recommends that for children younger than 5 years primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. TThe USPSTF recommends that for children younger than 5 years that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. Bright Futures recommends Fluoride varnish from ages 6 months through 4 years old and Fluoride supplementation risk assessment from ages 6 months through 16 years of age.1 quarterly0 through age 16 years oldGroup 199188, plus for risk assessment see codes in Wellness Visit.N/A
7Group B strep testing
performed one time during pregnancy
1 per pregnancyNoneGroup 1587081N/A
9Iron supplementation in children (routine iron supplementation for asymptomatic children 6-12 mo of age who are at increased risk for iron deficiency anemia) Healthcare Reform - Pharmacy BenefitNot applicable, administered through PharmacyNot applicable, administered through PharmacyN/A
7Gonorrhea Screening
USPSTF Rating B with Final Evidence Review 09/14/2021 The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection.
1 per year and 1 per year pregnantNoneGroup 1
Group 15
87590, 87591, 87592, 87801, 87850N/A
15Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Preventive Medication
USPSTF Rating A with Final Evidence Review 01/29/2019 The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.
NoneNoneNot applicable, administered through FacilityNot applicable, administered through FacilityThis medication is generally administered to newborn at birth facility.
19Sensory Screening - Hearing (beyond newborn screening)
Bright Futures recommends hearing screening at ages Newborn through age 21.
No LimitNewborn through 21 years of ageGroup 199382, 99383, 99384, 99385, 99392, 99393, 99394, 99395, 92551, 92558 or 92586N/A
8Hepatitis B Virus Infection in Adolescents and Adults: Screening
USPSTF Rating B with Final Evidence Review 12/15/2020 The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection.
1 per year Persons at high risk for infection and 1 per year pregnantAges 13-79 unless pregnant then at any ageGroup 1
Group 2
36415, 36416, 80055 , 80081, 86704, 86705, 86706, 87340, 87341, G0499N/A
8Hepatitis B Virus Infection in Pregnant Women: Screening
USPSTF Rating A with Final Evidence Review 07/23/2019 The USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit
1 per year Persons at high risk for infection and 1 per year pregnantNo age restrictionGroup 1
Group 2
Group 15
36415, 36416, 80055 , 80081, 86704, 86705, 86706, 87340, 87341N/A
8Hepatitis C Virus Infection in Adolescents and Adults: Screening
USPSTF Rating B with Final Evidence Review 03/02/2020 The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years.
1 every 10 yearsAges 18 - 79Group 286803, 87522, G0472, 36415, 36416N/A
8High Blood Pressure Screening
USPSTF Rating A with Final Evidence Review 04/27/2021 The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
Ages 18 and OlderGroup 1 may be used with 99385-99387 or 99395-99397. For coverage of 93784, 93786, 93788, 93790, A4670 must bill with R03.0.99385-99387 or 99395-99397 For ambulatory blood pressure monitoring use 93784, 93786, 93788, 93790 For home blood pressure monitor use A467099385-99387 or 99395-99397 are part of the wellness visit
16Prevention of Acquisition of HIV: Preexposure Prophylaxis (Persons at high risk of acquiring HIV. Offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition, including monitoring required prior to initiation of therapy and during drug therapy). USPSTF Rating A with Final Evidence Review 08/22/2023 The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons who are at increased risk of HIV acquisition to decrease the risk of acquiring HIV.Z11.4Office visits 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99417, G0463 Blood draw 35415, 35416 Renal Function Testing 82565, 82575, 80069, 81003 Pregnancy Related Testing 81025, 84702, 84703, 80055, 80081 Behavioral Health counseling 99401, 99402, 99403, 99404, G0445 Chlamydia Infection Screening 87110, 87270, 87320, 87490, 87491, 87801, 87810 Gonorrhea Screening 87590, 87591, 87801, 87850 Hepatitis B Virus Infection Screening 87340, 80055, 80081 Hepatitis C Virus Infection Screening 86803, G0472 HIV Screening G0432, G0433, G0435, G0475, S3645 Syphillis Screening 86592, 86780, 80055, 80081 Bone Density Study 77080, 77081 For medications covered at 100% please use the Formulary Lookup Tool on AlliantPlans.com
8Human Immunodeficiency Virus (HIV) Infection: Screening
USPSTF Rating A with Final Evidence Review 06/11/2019 The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. USPSTF Rating A with Final Evidence Review 06/11/2019 The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened.
1 per year Persons at high risk and 1 per year pregnantAges 15 - 65 unless pregnant then at any ageGroup 2
Group 15
86689, 86701, 86702, 86703, 87389, 87390, 83791, 87806, G0432, G0433, G0435, G0475, S3645, 36415, 36416, N/A
8Hypertensive Disorders of Pregnancy: Screening
USPSTF Rating B with Final Evidence Review 09/19/2023 The USPSTF recommends screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy.
No limitNoneGroup 1599385-99387 or 99395-99397 For ambulatory blood pressure monitoring use 93784, 93786, 93788, 93790 For home blood pressure monitor use A4670 For assessing proteinuria if suspect preeclampsia use 81000, 81001, 81002, 81003N/A
12Lead Screening
Bright Futures recommends lead risk assessment to be performed at ages 6 months, 9 months, then perform a screening or risk assessment at 12 months, then a risk assessment at 18 months, then another screening or risk assessment at 24 months, then a risk assessment at 3 years, 4 years, 5 years, 6 years.
No LimitAges 7 and UnderGroup 183655, 36415, 36416. For risk assessment see wellness visit codes.N/A
12Lung Cancer Counseling
visit to discuss need for Screening
1 per yearAges 50 - 80Group 3G0296N/A
12Lung Cancer: Screening
USPSTF Rating B with Final Evidence Review 03/09/2021 The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
1 per yearAges 50 - 80Group 371271Prior Authorization Required.
8Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling Interventions
USPSTF Rating B with Final Evidence Review 11/24/2020 The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity.
1 - Preventive BenefitAges 6 and OverNo specific diagnosis code requiredMedical Nutrition Therapy: 97802, 97803, 97804, G0270, G0271, S9470 Preventive Medicine Counseling: 99401, 99402, 99403, 99404 Behavioral Counseling: 0403T, G0446, G0447, G0473N/A
15Obesity in Children and Adolescents: Screening
USPSTF Rating B with Final Evidence Review 06/20/2017 The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.
1 - PreventiveAges 6 and OverNo specific diagnosis code requiredMedical Nutrition Therapy: 97802, 97803, 97804, G0270, G0271, S9470 Preventive Medicine Counseling: 99401, 99402, 99403, 99404 Behavioral Counseling: 0403T, G0446, G0447, G0473N/A
15Osteoporosis to Prevent Fractures: Screening
USPSTF Rating B with Final Evidence Review 06/26/2018 The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. USPSTF Rating B with Final Evidence Review 06/26/2018 The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.
1 every two yearsAges 65 and Older unless high risk in which case is age 20 and olderGroup 11
Group 12
76977, 77078, 77080, 77081, 77085, G0130N/A
16Prostate Screening1 AnnuallyMales Ages 50 - 70Group 1
Group 10
84152, 84153, 84154, G0102 G0103N/A
20Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions
USPSTF Rating A with Final Evidence Review 01/19/2021. The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and US Food and Drug Administration (FDA)--approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. USPSTF Rating A with Final Evidence Review 01/19/2021 The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco.
1 AnnuallyNoneNo specific diagnosis code required99401, 99402, 99403, 99404, 99406, 99407. Pharmacotherapy is administered through the Pharmacy Benefit - information is available on the Formulary Lookup Tool.N/A
20Tobacco Use in Children and Adolescents: Primary Care Interventions
USPSTF Rating A with Final Evidence Review 04/28/2020 The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents.
1 AnnuallyNoneNo specific diagnosis code required99401, 99402, 99403, 99404, 99406, 99407N/A
19Syphilis Screening Infection in Nonpregnant Adolescents and Adults: Screening
USPSTF Rating A with Final Evidence Review 09/27/2022 The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. Syphilis Infection in Pregnant Women: Screening USPSTF Rating A with Final Evidence Review 09/24/2018 The USPSTF recommends early screening for syphilis infection in all pregnant women.
1 per year Persons at increased risk and 1 per year pregnantNoneGroup 1
Group 2
Group 15
86592, 86593, 86780, 0064U, 0065U, 0210U, 80055, 80081, 36415, 36416, N/A
19Syphilis Infection in Pregnant Women: Screening
USPSTF Rating A with Final Evidence Review 09/04/2018 The USPSTF recommends early screening for syphilis infection in all pregnant women.
1 per year Persons at increased risk and 1 per year pregnantNoneGroup 1
Group 2
Group 15
86592, 86593, 86780, 0064U, 0065U, 0210U, 80055, 80081, 36415, 36416, N/A
19Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication
USPSTF Rating B with Final Evidence Review 08/23/2022 The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (i.e. dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater.
1 annuallyAges 40-75 yearsBill with one of the Group 1 - Encounter Codes Preventive benefit does not apply if a lipid disorder diagnosis is present in any position on the claim. Lipid disorder diagnosis codes are considered to be as follows: E71.30, E75.5, E78.00, E78.01, E78.2, E78.3, E78.41, E78.49, E78.5, E78.79, E78.81, E78.89, E88.2, E88.8980061, 82465, 83718, 83719, 83721, 83722, 84478, 36415, 36416N/A
12Latent Tuberculosis Infection in Adults (LTBI): Screening
USPSTF Rating B with Final Evidence Review 05/02/2023 The USPSTF recommends screening for LTBI in populations at increased risk.
1 annually18 years and upGroup 136415, 36416, 86480, 86481, 86580, Plus a follow up visit for review of result - 99211 N/A
20Tuberculosis (TB) Testing
Bright Futures Recommendations for Preventive Pediatric Health Care shows TB testing recommended from infant through 21 years old. For benefit from 18-21 also refer to the benefit for Latent Tuberculosis Infection in Adults (LTBI): Screening.
NonePrenatal through age 21Group 186580 Plus a follow up visit for review of result - 99211 N/A
22Vision in Children Ages 6 Months to 5 Years: Screening
USPSTF Rating B with Final Evidence Review 09/05/2017 The USPSTF recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors. Bright Futures Recommendations for Preventive Pediatric Health Care shows recommendations for vision screening to be performed from age newborn through 21 years of age.
No LimitNewborn through 21 years of ageGroup 199173 99174 99177N/A
23Wellness Exams Include the following service when applicable:
Developmental Surveillance - History and assessment of the physical state (height, weight, BP (blood pressure), BMI (body mass index)) - Screening and counseling for interpersonal and domestic violence The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services - UV light exposure counseling for persons age 6 months to 24 years
Follows Pediatric Guidelines (Bright Futures) for ages 3 and under for ages 4 and older is 1 annually and for ages 11 and older is 1 annually with availability to see OBGYN for preventive careSee Frequency Covered at Preventive Benefit for detailsGroup 1G0402 - G0405 G0438 - G0439 99401 - 99404 99411, 99412, 99429, 99381 - 99387, 99391 - 99397, S0302, 80050, 81002, 81003, 84443, 82951, 82952, 86704, 86705, 86706, 86900, 87522, 99000, 80053, 36415, 36416N/A
9Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening
USPSTF Rating B with Final Evidence Review 10/23/2018 The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services.
See Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examN/A
18Rh(D) Incompatibility: Screening
USPSTF Rating A with Final Evidence Review 02/15/2004 The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. USPSTF Rating B with Final Evidence Review 02/15/2004 The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative.
2 per pregnancy - The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative. NoneGroup 1586850, 86901, 36415, 36416N/A
8Healthy Weight and Weight Gain In Pregnancy: Behavioral Counseling Interventions
USPSTF Rating B with Final Evidence Review 05/25/2021 The USPSTF recommends that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy.
1 - Preventive BenefitAges 6 and OverNo specific diagnosis code requiredMedical Nutrition Therapy: 97802, 97803, 97804, G0270, G0271, S9470 Preventive Medicine Counseling: 99401, 99402, 99403, 99404 Behavioral Counseling: 0403T, G0446, G0447, G0473N/A
8Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling Interventions
USPSTF Rating B with Final Evidence Review 11/24/2020 The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity.
1 - Preventive BenefitAges 6 and OverNo specific diagnosis code requiredMedical Nutrition Therapy: 97802, 97803, 97804, G0270, G0271, S9470 Preventive Medicine Counseling: 99401, 99402, 99403, 99404 Behavioral Counseling: 0403T, G0446, G0447, G0473N/A
19Sexually Transmitted Infections: Behavioral Counseling
USPSTF Rating B with Final Evidence Review 08/18/2020 The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs).
G0445 is limited to semiannualNoneNo specific diagnosis code requiredG0445, 99401, 99402, 99403, 99404May be part of wellness visits.
23Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions
USPSTF Rating B with Final Evidence Review 09/18/2018 The USPSTF recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions.
1 - Preventive BenefitAges 6 and OverNo specific diagnosis code requiredMedical Nutrition Therapy: 97802, 97803, 97804, G0270, G0271, S9470 Preventive Medicine Counseling: 99401, 99402, 99403, 99404 Behavioral Counseling: 0403T, G0446, G0447, G0473N/A
19Skin Cancer Prevention: Behavioral Counseling
USPSTF Rating B with Final Evidence Review 03/20/2018 The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.
See Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examSee Wellness Exam as this service is included in a preventive care wellness examN/A