Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut ADMIN.00002 Preventive Health Guidelines Form


Preventive Services Recommendations

Notes: Coverage is based on the recommendations of specified organizations and is subject to change with updates from these organizations. When there's an existing, more specific medical policy or clinical UM guideline for a particular service, that policy will take precedence.

Indications

(838151) Is the preventive service in question recommended by a referenced organization listed in the policy? 

Contraindications

(838152) Does a specific medical policy or clinical UM guideline take precedence over the referenced preventive services guidelines for the topic in question? 
Effective Date

06/28/2023

Last Reviewed

05/11/2023

Original Document

  Reference



Preventive services span a broad range of care for individuals of all ages. Several national organizations produce evidence-based guidelines for these services.

Note: Please see the following document for information related to immunizations:

  • ADMIN.00007 Immunizations

Note: Please see the following document for additional information related to specific screenings for colorectal cancer:

  • CG-SURG-01 Colonoscopy

Note: For criteria related to specific screenings for breast cancer using MRI, refer to applicable guidelines used by the plan.

Position Statement

Medically Necessary:

The following lists of sources of preventive services recommendations created by the referenced organizations listed below are considered medically necessary. 

When these recommendations are updated by their sponsoring organizations, the update is considered medically necessary as of the effective date of the update of the recommendation.

If there is a specific medical policy or clinical UM guideline that encompasses a topic addressed in any of these referenced guidelines, the specific medical policy or clinical UM guideline will take precedence.