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Provider Handbook
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Clinical Preventive Services |
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Preventive care is diagnostic and includes medical procedures not related directly to a specific illness, injury, or definitive set of symptoms or obstetrical care, but rather medical procedures performed as periodic health screening, health assessment, or health maintenance visits. Certain services may be provided during acute and chronic care visits or during preventive care visits for asymptomatic individuals to maintain and promote good health. Additionally, clinical preventive services include immunizations, periodic screening examinations, well-child care for children up to 6 years old, and other disease prevention examinations. |
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Cancer Screenings |
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- Colonoscopy—Individuals of average risk for colon cancer are covered once every ten years beginning at age 50. For individuals with increased risk of colon cancer, these are the recommended age ranges and frequencies:
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- Hereditary non-polyposis colorectal cancer syndrome: Colonoscopy should be performed every two years beginning at age 25, or five years younger than the earliest age of diagnosis of colorectal cancer in an affected relative, whichever is earlier. Annual screening should be performed after age 40.
- Familial risk of sporadic colorectal cancer: First-degree relatives with sporadic colorectal cancer or adenomas before the age of 60 or multiple first-degree relatives with colorectal cancer or adenomas. Colonoscopy should be performed every three to five years beginning 10 years earlier than the youngest affected relative.
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- Fecal Occult Blood Testing—Annually starting at age 50 and above.
- Mammograms—Annually for those over age 39. If your patient is at high risk for breast cancer, a baseline mammogram is appropriate at age 35, then annually thereafter.
- Physical Examination—Digital rectal examination should be performed on individuals 40 years of age and older.
- Proctosigmoidoscopy or Sigmoidoscopy—Once every three to five years after age 50.
- Routine Pap Smears—Annually starting at age 18 (or younger if sexually active). Frequency may be less often at your and the patient’s discretion, but not less than every three years.
- Skin Cancer—Exams may be sought at any age by individuals at high risk with a family history or increased sun exposure.
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Cardiovascular |
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A cholesterol test (non-fasting) should occur once every five years beginning at age 18. Blood pressure should be tested annually for children ages 3 to 6 and a minimum of every two years thereafter and for adults. |
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Hearing |
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Preventive hearing examinations are only allowed under the well-child care benefit. Preventive hearing screenings are also covered for all high-risk neonates as defined by the Joint Committee on Infant Hearing. A newborn audiology screening should be performed on high-risk newborns prior to hospital discharge or within the first three months using Evoked Otoacoustic Emission and/or Auditory Brainstem Response testing. Evaluative hearing tests may be performed at other ages during routine exams. |
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Human Papillomavirus Vaccine |
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The Human Papillomavirus Virus (HPV) vaccine was developed to prevent cervical cancer. Effective October 1, 2006, the vaccine is covered by TRICARE. TRICARE is following the Centers for Disease Control and Prevention (CDC) guidelines. The recommended age for initial administration is 11-12, or age range of 13-26, if not previously administered. The CDC has determined that it can be safely administered for girls as early as age 9. After the age of 26, no efficacy has been established; therefore, it will not be a covered benefit. |
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Immunizations |
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Age-appropriate doses of vaccines are recommended and adopted by the CDC Advisory Committee on Immunization Practices (ACIP). Refer to the CDC web site for a current schedule of recommended vaccines. Note: Immunizations required for ADFMs whose sponsors have permanent change-of-station orders to overseas locations are covered as an outpatient office visit.
The influenza vaccine is recommended by the ACIP on the CDC Web site. Each year, coverage for influenza vaccination is provided by TRICARE for beneficiaries who meet the CDC’s specified criteria for high risk. Beneficiaries using TRICARE Standard or TRICARE Extra have the same coverage as those enrolled in TRICARE Prime, TPR, or TPRADFM for the vaccine, and the TRICARE Standard and TRICARE Extra deductible and cost-shares will apply.
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