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DESCRIPTIONHealthy You! is a wellness benefit that provides an “annual” wellness visit with a Network Provider. Healthy You! covers health screenings and immunizations based on age and gender, and can help identify potential health risks before they become serious.
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.
POLICYMembers are allowed only one Healthy You! visit per calendar year.
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.
POLICY EXCEPTIONSFederal Employee Program (FEP)
State Health Plan (State and School Employees)
POLICY GUIDELINESThe coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
12/01/2010: Policy added.
08/04/2015: Code Reference section updated for ICD-10.
01/01/2016: Policy statement updated to add Stool for Occult Blood to the list of not medically necessary wellness procedures as this test has been removed from the Healthy You! benefit effective 01/01/2016. Removed HPV testing from the list of not medically necessary wellness procedures as HPV testing has been added under the Healthy You! benefit for the ages and intervals specified in the Healthy You! Wellness Procedures coding guidelines effective 01/01/2016.
06/06/2016: Policy number added.
SOURCE(S)Blue Cross & Blue Shield of Mississippi Healthy You! Wellness Guide
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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