Preventive Care and Screening Services — Coverage Criteria
Governs coverage, frequency, and coding for preventive screenings, counseling, immunizations, breastfeeding equipment and related services for members under ConnectiCare/EmblemHealth plans, with distinctions for non‑grandfathered and grandfathered plans and network vs out‑of‑network providers.
Added Respiratory Syncytial Virus (RSV) Vaccine code 90683 effective 5/31/2024.
Added Pneumococcal Conjugate code 90684 effective 6/17/2024.
Removed age requirements for Dengue vaccine CPT code 90587; provider must adhere to FDA/CDC age/frequency guidelines.
Addition of CPT code 87626 for Human Papillomavirus (HPV) screening (DNA) effective 1/1/2025.
Deleted CPT code 0500T indicated for HPV screening.
Updated BRCA genetic testing counseling/evaluation codes to include CPT 99401–99404 and deletion of CPT 96040 effective 1/1/2025.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.