Preventive care services

The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA) has designated the services listed below as preventive benefits and available with no cost-sharing when provided by an in-network provider. This information is intended as a reference tool for your convenience and is not a guarantee of payment. This guide is subject to change based on new or revised laws and/or regulations, additional guidance and/or medical policy.

**Services are still subject to medical management criteria**

Preventive care services that may be provided during a wellness examination:
  • Administration/Interpretation of Health Risk
  • Assessment Instrument
  • Anxiety screening
  • Autism screening
  • Blood pressure measurement for high blood pressure screening/Preeclampsia screening
  • Breast-feeding counseling/support
  • Counseling/education to minimize exposure to ultraviolet radiation
  • Counseling to prevent initiation of tobacco use
  • Counseling related to sexual behavior/sexually transmitted infection (STI) prevention including HIV Preexposure Prophylaxis (PrEP) related adherence counseling and pre- and post prescription follow up counseling
  • Critical congenital heart disease screening
  • Depression screening/Maternal depression screening
  • Discussion of aspirin prophylaxis

Click here to view the full preventive services code list.

  • Discussion of chemoprevention with women at risk for breast cancer
  • Discussion/referral for genetic counseling/evaluation for BRCA testing
  • Hearing and vision screening
  • Intimate partner/interpersonal and domestic violence screening/referral to support services
  • Obesity screening/counseling regarding weight loss, healthy diet and exercise
  • Oral health assessment/discussion of water fluoridation/referral to dental home
  • Psychosocial/Behavioral assessment
  • Tobacco use screening/counseling
  • Unhealthy Alcohol use and substance abuse screening/counseling
  • Urinary incontinence screening