Well-woman preventive and family planning services
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Defines coverage and provider reminder for annual well-woman preventive visits, screening, counseling, and family planning services (including preconception counseling and LARC/IPLARC) for Health Choice Arizona members.
No material clinical or coverage changes in this revision.
Covered Services and Scope
Covered services within well-woman visit
Covered when provided as part of the annual well-woman preventive care visit:
Preconception counseling does not include genetic testing.
Preconception counseling is covered as part of the annual well-woman preventive care visit and includes discussion of healthy lifestyle before and between pregnancies, reproductive history and sexual practices, healthy weight and nutrition (including folic acid), physical activity, oral health, chronic disease management, emotional wellness, tobacco and substance use, and recommended intervals between pregnancies. Preconception counseling does not include genetic testing.
Billing and Coding Notes
| No codes listed |
Provider Requirements and Billing Actions
Prior authorization not required
No prior authorization is required for well-woman services; LARC and IPLARC services are reimbursed through regular claims processes and do not require separate prior authorization.
No step therapy required
There are no step therapy requirements described in this policy for well-woman, family planning, or LARC/IPLARC services.
Document components of the well-woman visit
Document the annual well-woman preventive visit to include the annual physical exam, clinical breast and pelvic exams, review/administration of immunizations and age-appropriate screenings, and any counseling, screening, testing, or treatments performed as part of the visit.
- Clinical breast and pelvic exams per current best practice recommendations
- Immunizations, screenings, and testing appropriate for age and risk
- Screening and counseling for nutrition/weight, tobacco/substance use, interpersonal violence, depression, STIs/HIV, and family planning
- Documentation of preconception counseling topics when provided (reproductive history, healthy weight and supplements including folic acid, physical activity, oral health, chronic disease management, emotional wellness, and recommended intervals between pregnancies)
No explicit denial triggers listed
The policy does not list any explicit denial triggers for services provided as part of the annual well-woman preventive visit.
Background and Purpose
The purpose of the annual well-woman visit is to assess overall health and provide preventive screening, counseling, and treatment for reproductive-aged women. Typical components include an annual physical exam and clinical breast and pelvic exams per current best practice; review and administration of immunizations; age- and risk-appropriate screenings and testing; and screening, counseling, and treatment for positive results such as nutrition and weight management, tobacco/substance use, interpersonal violence, depression and mental wellbeing, sexually transmitted infections including HIV, and family planning. Family planning counseling includes information on contraceptive options such as LARC and IPLARC, which are reimbursed through regular claims processes.
Key Definitions
Policy Revision History
Notice published reminding providers of coverage for annual well-woman preventive and family planning services, including preconception counseling and reimbursement of LARC/IPLARC via regular claims.
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