United Healthcare: Preventive Care Guideline Changes

The United Healthcare’s (UHC) Preventive Care Services Coverage Determination Guideline (CDG), which helps doctors identify and correctly code preventive services they deliver to our members, will making a few updates this year. The CDG defines the services, diagnoses, and other requirements to ensure that certain services are paid with preventive benefits and covered without cost-share under most plans.

The CDG is updated when new guidance is received about services that must be covered as preventive services and whenever the applicable codes are revised. The U.S. Preventive Services Task Force (USPSTF) is one of the primary references driving changes to the CDG. Items that have an “A” or “B” rating must be covered without cost-share by non-grandfathered plans.

Upcoming Changes to UHC Preventive Services CDG include the following updates:

  • High Blood Pressure Screening in Adults – Beginning October 1, 2016, UHC Preventive Care Services CDG will include codes for ambulatory blood pressure screening at home.
  • Abnormal Glucose and Type 2 Diabetes Mellitus in Adults Screening – Beginning October 1, 2016, UHC adds the benefit for obese and overweight individuals aged 40 to 70.  UHC will continue to include screening for individuals with hypertensive diagnoses as a preventive services benefit – age limit applies.  There is a separate benefit for gestational diabetes that has no age limit.
  • Iron Deficiency Screening in Pregnant Women– Codes removed from CDG – Beginning October 1, 2016, UHC will remove this benefit from the Preventive Care Services CDG on October 1, 2016.

The UHC Preventive Care Services CDG is available on the United for Reform Resource Center.

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.