Preventive health services and coding

Preventive care services are for patients without recognized signs or symptoms of the target condition. Screening is the testing for disease in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease.

If a screening service results in a diagnosis of a condition, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable.

Preventive Health Benefits and Coding Guidelines provide additional information related to specific types of preventive services, as defined under the Patient Protection and Affordable Care Act (ACA), which may be covered under a Member’s Benefit Plan depending on factors such as grandfathered status, product type and anniversary date, and contraception exemptions.

Preventive Health Services and Coding Guidelines

Contact Provider Service for specific coverage information.