Fillable Printable 310-H, Health Risk Assessment And Screening Tests
Fillable Printable 310-H, Health Risk Assessment And Screening Tests
310-H, Health Risk Assessment And Screening Tests
CHAPTER 300
MEDICAL POLICY FOR AHCCCS COVERED SERVICES
POLICY 310
COVERED SERVICES
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM 310-16
AHCCCS MEDICAL POLICY MANUAL
310-H HEALTH RISK ASSESSMENT AND SCREENING TESTS
REVISION DATES: 10/01/13, 10/01/10, 10/01/06, 01/01/04, 10/01/01
INITIAL
EFFECTIVE DATE: 10/01/1994
DESCRIPTION
AHCCCS covers health risk assessment and screening tests provided by a physician,
primary care provider or other licensed practitioner within the scope of his/her practice
under State law for all members. These services include appropriate clinical heath risk
assessments and screening tests, immunizations, and health education, as appropriate for
age, history and current health status.
Health risk assessment and screening tests are also covered for members under the Early
and Periodic Screening, Diagnosis and Treatment Program and KidsCare Program. Refer to
AMPM Chapter 400 for complete details.
AMOUNT, DURATION AND SCOPE
Preventive health risk assessment and screening test services for non-hospitalized adults
include, but are not limited to:
1. Hypertension screening (annually)
2. Cholesterol screening (once, additional tests based on history)
3. Routine mammography annually after age 40 and at any age if considered
medically necessary
4. Cervical cytology, including pap smears (annually for sexually active women;
after three successive normal exams the test may be less frequent)
5. Colon cancer screening (digital rectal exam and stool blood test, annually after
age 50, as well as baseline colonoscopy after age 50)
6. Sexually transmitted disease screenings (at least once during pregnancy, other
based on history)
7. Tuberculosis screening (once, with additional testing based on history, or, for
AHCCCS members residing in a facility, as necessary per health care institution
licensing requirement)
CHAPTER 300
MEDICAL POLICY FOR AHCCCS COVERED SERVICES
POLICY 310
COVERED SERVICES
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM 310-17
AHCCCS MEDICAL POLICY MANUAL
8. HIV screening
9. Immunizations (refer to AMPM Policy 310-M, Immunizations for details)
10. Prostate screening (annually after age 50; and, screening is recommended
annually for males 40 and older who are at high risk due to immediate family
history), and
11. Physical examinations (as of 10/01/13, includes well visits and well exams),
periodic health examinations or assessments, diagnostic work ups or health
protection packages designed to: provide early detection of disease; detect the
presence of injury or disease; establish a treatment plan; evaluate the results or
progress of a treatment plan or the disease; or to establish the presence and
characteristics of a physical disability which may be the result of disease or
injury
Screening services provided more frequently than these professionally recommended
guidelines will not be covered unless medically necessary.
Physical examinations not related to covered health care services or performed to satisfy
the demands of outside public or private agencies such as the following are not covered
services:
1. Qualification for insurance
2. Pre-employment physical examination
3. Qualifications for sports or physical exercise activities
4. Pilots examinations (Federal Aviation Administration)
5. Disability certification for the purpose of establishing any kind of periodic
payments
6. Evaluation for establishing third party liability, or
The AHCCCS Division of Fee-For-Service Management does not require prior
authorization for medically necessary health risk assessment and screening services
performed by Fee-For-Service providers.
