Figure 4.3 provides coverage details for clinical preventive services. Note: This chart is not intended to be all-inclusive.
Clinical Preventive Services: Coverage Details
Figure 4.3
Service
Description
Health Promotion and Disease Prevention Examinations
Office visits may be covered for the following services (subject to age and other criteria):
Cancer screening examinations and services (breast cancer, cancer of female reproductive organs, colorectal cancer, and prostate cancer)
Infectious diseases (Hepatitis B screening, human immunodeficiency virus [HIV] testing) and preventive therapy when at-risk (tetanus, animal bite, Rh immune globulin, and exposure to certain infectious diseases, including tuberculosis)
Genetic testing and counseling for certain clinical indications during pregnancy
Other: routine chest X-rays and electrocardiograms required for admission when a patient is scheduled to receive general anesthesia on an inpatient or outpatient basis
Immunizations
Covered for age-appropriate dose of vaccines as recommended by the Centers for Disease Control and Prevention. Immunizations for active duty family members whose sponsors have permanent change of station orders to overseas locations also are covered.
Other Health Promotion and Disease Prevention Services
The following services may be covered if provided in connection with a visit for immunizations, Pap smears, mammograms, or examinations for colon and prostate cancer:
Cancer screening (testicular, skin, oral cavity, pharyngeal, and thyroid)
Audiology screening (only allowed under well-child services)
Counseling services expected of good clinical practice that are included with the appropriate office visit at no additional charge (dietary assessment and nutrition; physical activity and exercise; cancer surveillance; safe sexual practices; tobacco, alcohol, and substance abuse; promoting dental health; accident and injury prevention; and stress, bereavement, and suicide risk assessment)
School Physicals
Covered for children ages 5-11 if required in connection with school enrollment.
Note: Annual sports physicals are not a covered benefit.
Well-child Services
Covered for beneficiaries from birth to age 6; includes visits, immunizations, and vision screening.
