Common Preventive Services

Many of you have asked, "What is classified as preventive care under my insurance policy?". Although preventive care may vary from policy to policy, listed below are the commonly accepted services and procedures. Check your policy for details.

Well-Child Care through Age 18 *

1) Six visits 0-12 months
2) Three visits 12-24 months
3) Annual visits age 24 months through age 18
4) Annual pap smear and pelvic exam, as appropriate by age
5) Lead level testing: once between ages 9-12 months; one at 24 months+
6) Immunizations: Hepatitis A&B; (DPT), Polio, (MMR)
7) Labs, pathology, chest x-ray and EKG (when performed as preventive care)


Adult Care after Age 18 *

1) Annual routine office visit and exam (physician’s time and knowledge)
2) Tetanus/Diphtheria booster every 10 years
3) Annual influenza vaccination (flu shot)
4) Pneumococcal vaccination once for age 65+
5) Cholesterol screening including triglycerides, LDL, HDL or Lipid panel once every 5 years for age 20+
6) Annual mammogram for age 40+
7) Annual pap smear and pelvic exam
8) Bone density test for women age 65+
9) Colorectal cancer screenings: annual fecal occult blood test; flexible sigmoidoscopy once every 5 years for age 50+, colonoscopy every 10 years for age 50+, or double barium enema every 5 years for age 50+.
10) Annual digital rectal exam and PSA for age 45+
11) Labs, pathology, chest x-ray and EKG (when performed as preventive care)


* Ask your attending physician to check with your insurance carrier to ensure these
procedures are covered by your policy. Diagnoses coding as “preventive” is imperative to
ensure these procedures are adjudicated as preventive care.


Note: Preventive Care guidelines follow recommendations from sources such as the American Cancer Society, U.S. Preventive Services Task Force, American Heart Association, and the American Academy of Pediatrics