Screening and Counseling Services. Screenings and counseling services will provide coverage for evidence-based services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force for individuals in certain age groups or based on risk factors. Key screenings include: • Preventive Physical Examinations • Health appraisal exams, laboratory and radiological tests, and early detection procedures for the purpose of a routine physical exam • Periodic tests to determine metabolic, blood hemoglobin, blood pressure, blood glucose level, and blood cholesterol level, or alternatively, a fractionated cholesterol level including a Low-Density Lipoprotein (LDL) level and a High-Density Lipoprotein (HDL) level • Periodic stool examination for the presence of blood for all persons 40 years of age or older • Colorectal cancer screening in accordance with the evidence-based recommendations established by the United States Preventive Services Task Force for determining the presence of pre-cancerous or cancerous conditions and other health problems including: o Fecal occult blood testing (FOBT) o Flexible Sigmoidoscopy o Colonoscopy, including anesthesia services o Virtual Colonoscopy - Requires Prior Authorization o Double contrast barium enema • Smoking Cessation Program - Refer to Smoking Cessation Counseling/Program in this Section. • Screening to determine the need for vision and hearing correction • Periodic glaucoma eye test • Preventive screening services including screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and sexually transmitted infections, as well as counseling for drug and Tobacco use, healthy eating and other common health concerns. • Health education and consultation from Practitioners/Providers to discuss lifestyle behaviors that promote health and well-being including, but not limited to, the consequences of Tobacco use, and/or smoking control, nutrition and diet recommendations, and exercise plans. For Members 19 years of age or older, health education also includes information related to lower back protection, immunization practices, breast self-examination, testicular self-examination, use of seat belts in motor vehicles and other preventive health care practices. Routine Immunizations Routine Immunization includes Coverage for Adult and Child Immunizations (shots or vaccines), in accordance with the recommendations of: • The American Academy of Pediatrics • The Advisory Committee on Immunization Practices • The ...
