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.