Currentblue cross blue shield - arizonaPolicy N/A

Well‑Woman Preventive and Family Planning Services Coverage Criteria

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Governance of coverage for an annual well-woman preventive care visit and associated screening, counseling, and preconception services for members; applies to providers delivering these preventive services under the payer.

Policy Summary

Payerblue cross blue shield - arizona

PolicyWell‑Woman Preventive and Family Planning Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDocument an annual well-woman exam including assessment of overall health, clinical breast and pelvic exams, immunizations, screenings, and testing as appropriate for age and risk factors.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

AnnualVisit frequency

Includes LARCLARC reimbursement

MultipleScreening domains

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Currentblue cross blue shield - arizonaPolicy N/A

Well‑Woman Preventive and Family Planning Services Coverage Criteria

Customize your policy alerts

Sign up for all blue cross blue shield - arizona policy alerts

Know when blue cross blue shield - arizona releases new policies or updates existing guidance.

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Policy Summary

Payerblue cross blue shield - arizona

PolicyWell‑Woman Preventive and Family Planning Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDocument an annual well-woman exam including assessment of overall health, clinical breast and pelvic exams, immunizations, screenings, and testing as appropriate for age and risk factors.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

AnnualVisit frequency

Includes LARCLARC reimbursement

MultipleScreening domains

Covered Preventive Services and Criteria

Covered preventive services during annual well-woman visit

Covered preventive services when delivered during the annual well-woman preventive care visit include the following screenings and counseling:

Annual visit components: Annual physical exam assessing overall health; clinical breast and pelvic exams according to current best practice recommendations; review and administration of immunizations, screenings, and testing as appropriate for age and risk factors.

Screening and counseling topics: Proper nutrition and physical activity, assessment of elevated BMI/obesity; tobacco/substance use/abuse/dependency; interpersonal and domestic violence screening; depression screening and mental wellbeing; sexually transmitted infections including HIV; family planning counseling.

Preconception counseling content: Discussion regarding a healthy lifestyle before and between pregnancies including reproductive history and sexual practices; healthy weight, diet, nutrition, supplements and folic acid; physical activity; oral health care; chronic disease management; emotional wellness; tobacco and substance use (including opioids, alcohol, marijuana and prescription drugs); and recommended intervals between pregnancies.

Preconception counseling does not include genetic testing.

Contraceptive services: Family planning counseling and Long Acting Reversible Contraceptive (LARC) services; LARC services are reimbursed through regular claims processes.

Preconception counseling addresses preparation for a healthy pregnancy and includes discussion of reproductive history and sexual practices; healthy weight, diet and nutrition including use of supplements and folic acid; physical activity; oral health; chronic disease management; emotional wellness; tobacco and substance use (including opioids, alcohol, marijuana and prescription drugs); and recommended intervals between pregnancies. Preconception counseling does not include genetic testing.

Provider Requirements, Billing, and Documentation

Note

Provider Action — None Specified

No specific provider actions are required beyond standard delivery of covered preventive and family planning services; the source document does not specify any additional provider action requirements or examples.

Documentation Required

Documentation Expectations for Annual Well‑Woman Visit

Documentation expectations for the annual well-woman visit: document the annual physical exam findings, clinical breast and pelvic exam (as appropriate per guidelines), screenings and immunizations reviewed/ administered, and counseling topics covered (nutrition, physical activity and BMI, tobacco/substance use, interpersonal/domestic violence screening, depression and mental wellbeing, STI/HIV screening, family planning counseling, and preconception counseling components such as reproductive history, healthy weight and nutrition including folic acid, physical activity, oral health, chronic disease management, emotional wellness, substance use, and recommended interpregnancy intervals). Note that preconception counseling does not include genetic testing.

Background and Clinical Context

The annual well-woman visit is a preventive visit intended to assess overall health and deliver age- and risk-appropriate screening, immunizations, and counseling. Covered screening and counseling topics include: proper nutrition and physical activity (including management of elevated BMI/obesity), tobacco and substance use screening, interpersonal and domestic violence screening, depression and mental wellbeing screening, sexually transmitted infection screening including HIV, and family planning counseling. Long Acting Reversible Contraceptive (LARC) services are reimbursed through regular claims processes.

Key Definitions

inv-08: Preconception counseling — definition and scope

DefinitionPreconception counseling: discussion regarding a healthy lifestyle before and between pregnancies covering reproductive history and sexual practices; healthy weight, diet, nutrition, supplements and folic acid; physical activity; oral health; chronic disease management; emotional wellness; tobacco and substance use (including opioids, alcohol, marijuana and prescription drugs); and recommended intervals between pregnancies.

ScopeDelivered as part of the annual well-woman preventive care visit and includes discussion and counseling on the topics listed above.

ExclusionPreconception counseling does not include genetic testing.

Related servicesIncluded within the same visit as other preventive screenings and family planning counseling.

Documentation expectationProviders should document the counseling topics addressed during the annual well-woman visit (see preventive visit documentation guidance).