The Department of Health and Human Services requires most benefit plans to include certain preventive care services to be covered without any out-of-pocket costs as long as participating health care provider provides the service.
We update our Coverage Determination Guidelines (CDG) for Preventive Care Services to help you identify and correctly code preventive services. This CDG is on uhcprovider.com/policies > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans or at uhcprovider.com/policies > For Exchange Plans > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Individual Exchange Plans.
We update the CDG when we receive new guidance about preventative services and revised codes. The United States Preventive Services Task Force is one of the primary references driving changes to the CDG. We must cover items that have an “A” or “B” rating without cost-share by non-grandfathered benefit plans. This applies to both fully insured and self-funded benefit plans. While grandfathered benefit plans are not required to implement these changes, some grandfathered benefit plans have chosen to cover preventive care services at no cost-share.
This does not apply to members enrolled in government health benefit plans (Medicare/Medicaid) including our MA benefit plans. For information on Medicare coverage of preventive services, go to uhcprovider.com/policies > Medicare Advantage Policies > Coverage Summaries for Medicare Advantage Plans > Preventive Health Services and Procedures. For more information visit: