Rule 5160-1-16 | Preventive services.
(A) "Preventive service" is a procedure, treatment, or other measure that is included in either of two groups:
(1) Services addressed in any of the following sources:
(a) "USPSTF A and B Recommendations" (January 2017), published by the United States preventive services task force and available at http://www.uspreventiveservicestaskforce.org;
(b) Immunization schedules for January 2017 published by the centers for disease control and prevention and available at http://www.cdc.gov;
(c) "Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 4th Edition" (2017), published by the American academy of pediatrics and available at http://www.aap.org; or
(d) "Recommendations for Preventive Services for Women" (December 2016), published by the women's preventive services initiative and available at http://www.womenspreventivehealth.org; or
(2) Medically necessary procedures that meet the definition of "early and periodic screening, diagnostic, and treatment services" set forth in 42 U.S.C. 1396d(r) (as in effect in January 2017).
(B) Payment may be made for a preventive service and necessary related services (e.g., medications, procedures, devices, tests, education, and counseling) when both of the following conditions are met:
(1) A practitioner in an appropriate discipline, acting within the scope of practice authorized under state law, has determined, on the basis of at least one risk factor, that the preventive service is indicated for a particular individual; and
(2) The preventive service is provided in accordance with nationally recognized, evidence-based frequency schedules.
Five Year Review Date: 10/1/2022
Prior Effective Dates: 4/7/1977, 12/21/1977, 12/30/1977, 7/1/1980, 10/1/1987, 9/1/1989, 4/1/1992 (Emer.), 7/1/1992, 7/1/1993, 1/4/2000 (Emer.), 3/20/2000, 12/31/2001 (Emer.), 3/9/2002, 12/30/2005 (Emer.), 3/27/2006, 11/13/2006, 7/1/2009, 12/22/2011