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PREVENTIVE CARE
The following Preventive Health Care Services DO NOT require authorization:
Preventive Care
Abdominal Aortic Aneurysm Ultrasound: A
one-time screening ultrasound for people at risk
(like people who have smoked).
Influenza Vaccine (once a year in fall winter)
Bone Mass Measurements [Dexascan]:
Every 24 months; more often if medically
necessary
Glaucoma Test: once every 12 months)
indicated for those at high risk for glaucoma
Cardiovascular Testing: Electrocardiogram
and cardiovascular blood screenings to check
cholesterol and other blood fat (lipid) levels
Hepatitis B Vaccine: Three shots are needed for
complete protection. Indicated for those at
medium to high risk for Hepatitis B.
Medical Nutrition Therapy Services: For
Members with diabetes or kidney disease and
your doctor refers you for the service
Mammogram: once every 12 months for
Members 40 years and older)
Colorectal Screening: Fecal Occult Blood Test
once every 12 months if age 50 or older.
OR
Flexible sigmoidoscopy generally, once every
48 months if age 50 or older, for those not at
high risk, 120 months after a previous screening
colonoscopy
OR
Screening Colonoscopy generally once every
120 months (high risk every 24 months), 48
months after a previous flexible sigmoidoscopy.
No minimum age.
Pap & Pelvic Exams: Once every 24 months for
women at low risk, and once every 12 months for
women at high risk and for women of child-
bearing age who have had an exam that indicated
cancer or other abnormalities in the past three
years
Colorectal Screening: Barium Enema - once
every 48 months if age 50 or older (high risk
every 24 months) when used instead of a
sigmoidoscopy or colonoscopy.
Pneumococcal Vaccine: Generally once per
lifetime
Diabetes Screening (Fasting Plasma Glucose
Test): Member may be eligible for up to two
screenings each year
*see definition for coverage
Prostate Cancer Screening: Digital Rectal
Examination once every 12 months;
Prostate Specific Antigen (PSA) Test once every
12 months
Routine Physical Exams
