Preventive Care Services for:
Adults
| Assessment, screening & counseling | Recommendation |
|---|---|
| Abdominal aortic aneurysm | One-time screening for men ages 65 - 75 years who have smoked |
| Alcohol misuse screening and counseling | Interventions to reduce alcohol misuse |
| Aspirin prevention medication | Recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10% or greater 10-year cardiovascular risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years |
| Blood pressure screening | For adults age 18 and older |
| Cholesterol screening | For men ages 35 and older and women 45 and older or starting at 20 if you are at increased risk for coronary heart disease |
| Colorectal cancer screening | For adults ages 50 - 75 |
| Depression screening | For all adults |
| Diabetes screening | For adults ages 40 and older who are overweight or obese |
| Healthy diet and physical activity counseling | For adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors |
| Hepatitis B screening | For adults at high risk |
| Hepatitis C screening | For adults born between 1945 - 1965 |
| Human immunodeficiency virus (HIV) screening | For adults at increased risk |
| Lung cancer screening | For adults ages 55 - 80 who have smoking history or currently smoke |
| Nutritional therapy members with diabetes or renal disease | Medicare coverage when the following are true:
|
| Obesity screening and counseling | For adults with body mass index of 30 kg/m2 or higher |
| Prostate cancer screening | For men who is at least 50 years of age with no symptoms or who is at least 40 years of age and has family history of prostate cancer |
| Sexually transmitted infection (STI) counseling | For all sexually active adolescents and adults at increased risk for STIs |
| Statin preventative medication | For adults ages 40-75 of age with no history of cardiovascular disease (CVD), 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater |
| Tobacco use counseling and interventions | For adults to provide behavioral intervention to help stop using tobacco and FDA approved cessation products |
| Syphilis screening | For adults that are at high risk |
| Tuberculosis screening | For adults at increased risk |
| Skin cancer counseling | For adults ages 10 - 24 who have fair skin and are at high risk |
| Exercise and physical therapy | For adults ages 65 and older who are at increased risk for falls |
| Vitamin D supplements | For adults age 65 and older who are at increased risk for falls |
| Wellness visits | Comprehensive evaluation and management services |
Women
| Assessment, screening & counseling | Recommendation |
|---|---|
| BRCA risk assessment and genetic counseling/testing | For women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes |
| Breast cancer mammography screening | For women ages 35 and older. Screening includes digital breast tomosynthesis (DBT) |
| Breast cancer preventive medication | For women who are at increased risk for breast cancer and have no prior diagnosis of breast cancer |
| Cervical cancer (Pap Smear) screening | For women ages 18 - 65 years |
| Contraceptive counseling and contraception methods | FDA-approved contraceptive methods, sterilization procedures, education and counseling |
| Domestic violence and intimate partner violence | Screening and counseling |
| Folid acid supplements | For women planning or capable of pregnancy |
| Human immune-deficiency virus (HIV) screening and counseling | For all sexually active women |
| Human papilloma virus (HPV) screening | For women ages 18 - 65 years |
| Osteoporosis screening | For women ages 65 or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old women |
| Sexually transmitted infection (STI) screening | For chlamydia, gonorrhea and syphilis for sexually active women who are at high risk. |
| Well-woman visit | For women to obtain the recommended preventive services that are age and developmentally appropriate |
Pregnant Women
| Assessment, screening & counseling | Recommendation |
|---|---|
| Aspirin to prevent preeclampsia | Use of low-dose aspirin after 12 weeks of gestation if at high risk for preeclampsia |
| Bacteriuria screening with urine culture | Between 12 - 16 weeks gestation or during first prenatal visit if later |
| Breast pump and supplies | One electric breast pump per completed pregnancy |
| Breastfeeding support and interventions | Interventions during pregnancy and after birth to promote and support breastfeeding |
| Depression screening | For pregnant and postpartum women |
| Diabetes screening | After 24 weeks of gestation |
| Hepatitis B screening | First prenatal visit |
| Human immunodeficiency virus (HIV) screening | For all pregnant women |
| Preeclampsia screening | For pregnant women with blood pressure measurements throughout pregnancy |
| Rh incompatibility screening | First visit and follow-up for women at high risk |
| Routine maternity care | Prenatal visits and follow-up testing |
| Syphilis screening | During the pregnancy |
| Tobacco use counseling | For all pregnant women |
Children
| Assessment, screening & counseling | Recommendation |
|---|---|
| Alcohol misuse | Screening and counseling interventions for children 11 years and older to reduce alcohol misuse |
| Anemia screening | For children 1 year |
| Autism screening | At 18 and 24 months |
| Bilirubin screening | For newborn 0 - 30 days |
| Blood pressure screening | Starting at age 3 years |
| Critical congenital heart disease screening | For newborn after 24 hours of age, before discharge from hospital |
| Dental caries prevention | Application of fluoride varnish to primary teeth for all infants and children through age 5 years |
| Depression screening | For major depressive disorder in adolescents ages 12 - 18 years |
| Development screening | For children up to age 3 years |
| Dyslipidemia Screening | For children at high risk of lipid disorders ages 1 - 17 years |
| Gonorrhea prophylactic medication | For newborn for the prevention of gonococcal ophthalmia neonatorum |
| Height, weight and body mass index (BMI) | For children 0 - 20 years |
| Hearing loss screening | For newborn and children up to age 10 years |
| Hemoglobinopathies screening | For newborn 0 - 30 days |
| Human immune-deficiency virus (HIV) screening | For adolescents at increased risk |
| Hypothyroidism and metabolic disease screening | For newborn 0 - 30 days |
| Lead screening | For children 0 - 21 years |
| Length/Height and Weight | For children 0 - 21 years |
| Maternal depression screening | For children 0 - 6 months |
| Obesity screening and counseling | For children 6 - 21 years |
| Oral risk assessment (Dental) | For children 6, 9, 12, 18, 34 months and 6 years |
| Phenylketonuria screening | For newborn 0 - 30 days |
| Psychosocial/Behavioral assessments | For infants and children |
| Sexually transmitted infection (STI) screening and counseling | For adolescents who are at high risk |
| Tobacco, alcohol and drug use assessment | For children 11+ years |
| Tobacco use counseling | For ages 6 - 18 years to prevent initiation of tobacco use in school-aged children and adolescents |
| Tuberculosis screening | For children at high risk |
| Visual acuity screening | For all children at least once between ages 3 and 5 years to detect the presence of amblyopia or its risk factors |
| Well-child visit | Comprehensive evaluation and management services |
Immunizations for:
Vaccines recommended by Centers for Disease Control and Prevention (CDC). Doses, recommended ages and recommended population vary.
For recommendations and schedules, see Center for Disease Control and Prevention.
Children ages 0 through 6 years old
- Diphtheria, tetanus, & acellular pertussis (DTaP)
- Haemophilus influenza type b (Hib)
- Hepatitis A (HepA)
- Hepatitis B (HepB)
- Influenza (Flu)
- Measles, mumps, and rubella (MMR)
- Meningococcal
- Pneumococcal conjugate (PCV13)
- Polio
- Varicella
Adults 19 years old & older
- Haemophilus influenza type b (Hib)
- Hepatitis A (HepA)
- Hepatitis B (HepB)
- Herpes zoster (Shingles)
- Human papillomavirus (HPV)
- Influenza (Flu)
- Measles, mumps, and rubella (MMR)
- Meningococcal
- Pneumococcal conjugate (PCV13)
- Tetanus, Diphtheria, Pertussis (Td/Tdap)
- Varicella
Children ages 7 through 18 years
- Hepatitis A (HepA)
- Hepatitis B (HepB)
- Human papillomavirus (HPV)
- Influenza (Flu)
- Measles, mumps, and rubella (MMR)
- Meningococcal
- Pneumococcal conjugate (PCV13)
- Tetanus, Diphtheria, Pertussis (Td/Tdap)
- Polio
- Varicella