(continued)
Health screenings and interventions
SERVICE
GROUP CRITERIA AND FREQUENCY
The following tests will be covered for colorectal cancer screening, ages 45–75: • Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually • Flexible sigmoidoscopy every 5 years • Flexible sigmoidoscopy every 10 years + annual FIT • Double-contrast barium enema (DCBE) every 5 years • Colonoscopy every 10 years, including a follow-up colonoscopy, for when stool-based tests reveal abnormal results • Computed tomographic colonography (CTC)/virtual colonoscopy every 5 years – Requires prior authorization • Stool-based deoxyribonucleic acid (DNA) test (i.e., Cologuard) every 1–3 years
Colon cancer screening 1
Congenital hypothyroidism screening
Newborns
Critical congenital heart disease screening
Newborns before discharge from hospital
Contraception counseling/education (including fertility awareness-based methods); contraceptive products and services 1, 3, 4 Dental application of fluoride varnish to primary teeth at time of eruption (in primary care setting) Dental caries prevention Evaluate water source for sufficient fluoride; if deficient prescribe oral fluoride 1
Women with reproductive capacity
Children to age 6 years
Children older than 6 months
Depression screening/Maternal depression screening
Adults; Adolescents ages 12–18, including pregnant and postpartum women
9, 18, 30 months
Developmental screening
Newborn, 1, 2, 4, 6, 12, 15, 24 months. At each visit ages 3–21
Developmental surveillance
Community-dwelling adults ages 65 and older with risk factors
Fall prevention in older adults (including assessment of risk, individual and group exercise, and physical therapy)
Folic acid supplementation 1
Women planning or capable of pregnancy
Women at risk, including those with a personal or family history of breast cancer, ovarian cancer, tubal cancer or peritoneal cancer, or an ancestry associated with BRCA 1/2 gene mutation • Genetic counseling must be provided by an independent board-certified genetic specialist prior to BRCA1/BRCA2 genetic testing • BRCA1/BRCA2 testing requires precertification Pregnant women with no symptoms of diabetes, at 24 weeks of pregnancy or after
Genetic counseling/evaluation and BRCA1/BRCA2 testing
Gestational diabetes screening
Sexually active women age 24 years and younger and older women at risk
Gonorrhea screening
Ages 6 and older, including pregnant persons – to promote healthy weight status; individuals with risk factors for cardiovascular disease; behavioral health counseling while pregnant All newborns by 2 months. Ages 4, 5, 6, 8, 10. Adolescents once between ages 11–14, 15–17 and 18–21
Healthy diet and physical activity counseling
Hearing screening (not complete hearing examination)
Hemoglobin or hematocrit
12 months
Pregnant women; adolescents and adults at risk
Hepatitis B screening
Adults ages 18–79
Hepatitis C screening
Adults ages 18 and older without known high blood pressure
High blood pressure screening (outside clinical setting) 2
HIV Preexposure Prophylaxis (PrEP) for prevention of HIV infection 1 HIV PrEP related services (HIV screening, kidney function testing, hepatitis B & C screening, pregnancy testing, sexually transmitted infection screening/behavioral counseling, adherence counseling)
Individuals at risk
= Men
= Women
= Children/adolescents
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