Preventive Services

Preventive services are routine health care services that may include examinations and screenings tailored to a person’s age, gender, health, and history.

Covered services include the following (coverage for some vaccinations/screenings depend on age and/or gender):

1. Vaccinations
2. Child and Teen Checkups (C&TC)
3. Lead testing
4. Mammograms
5. Pap smear
6. Chlamydia screening.
   1. PrimeWest Health strongly recommends that all women ages 16 – 24 have an annual urine screen for chlamydia. The following codes reflect a completed chlamydia screening: 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87810, and 87800.
7. Colonoscopy
8. Diabetes care
   1. All PrimeWest Health members with a diagnosis code of diabetes should have a nephropathy screening test conducted annually. Documentation in the medical record must include the date indicating the date when a urine microalbumin test was performed, and the result. Any of the following meet the criteria for a urine microalbumin test:
      1. 24-hour urine for microalbumin
      2. Timed urine for microalbumin
      3. Spot urine for microalbumin
      4. Urine for microalbumin/creatinine ratio
      5. 24-hour urine for total protein
      6. Random urine for protein/creatinine ratio
   2. Any of the following meet the criteria for a positive urine macroalbumin test:
      1. Positive urinalysis (random, spot, or timed) for protein
      2. Positive urine (random, spot, or timed) for protein
      3. Positive urine dipstick for protein
      4. Positive tablet reagent for urine protein
      5. Positive result for albuminuria
      6. Positive result for macroalbuminuria
      7. Positive result for gross proteinuria
   3. Nephropathy screening codes include: 84156, 82042, 82043, and 82044

PW_11-19_535
Updated_11/27/2024