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Preventive health services are designed to effectively prevent or screen for a disease for which there is an effective treatment when discovered in an early stage. The majority of preventive health services covered under the Federal Healthcare Reform, Patient Protection and Affordable Care Act (PPACA) are already covered as part of the Healthy You! preventive wellness benefit and will not be reimbursed as a separate procedure. The Preventive Health Services policy provides the coverage guidelines for each preventive health service that must be covered under PPACA when delivered by a Network Provider. It also notes which preventive health services are covered as part of the Healthy You! wellness benefit.

Services billed outside of the Healthy You! Wellness Procedures coding guidelines will be denied as a not medically necessary wellness procedure.

The following procedures are not medically necessary wellness procedures and should not be routinely performed during a wellness visit.  This is not an all inclusive list.

• TSH, CMP, HPV, and other laboratory tests billed outside this policy
• EKG, Chest X-ray, and other radiological procedures billed outside this policy 

Covered Codes

Coverage will only be made for covered codes when used for services outlined within the Healthy You! Wellness Procedures coding guidelines. 

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