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| 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.
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| Immunizations |
Covered for age-appropriate dose of vaccines, including influenza, as recommended by the Centers for Disease Control and Prevention (CDC). Coverage for human papillomavirus (HPV) vaccine provided for initial administration for girls age 11-12, or if not previously administered, for girls age 13-26. |
| 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 and pharyngeal, and thyroid)
- Infectious disease (tuberculosis screening, Rubella antibodies)
- Cardiovascular disease (cholesterol screening, blood pressure screening)
- Body measurements (height and weight)
- Vision screening
- 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).
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| Pap Smear |
Covered as either a diagnostic or routine preventive procedure. The human papillomavirus (HPV) Pap test is not covered as a routine screening Pap smear. |
| School Physicals |
Covered for children ages 5–11 if required in connection with school enrollment. Note: Annual sports physicals are not covered. |
| Well-Child Care |
Covered from birth to age 6; includes office visits, immunizations, and vision screening. |
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