Preventive Care Services - Cigna

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Page 1 of 31 Administrative Policy: A004 Administrative Policy Effective 05/01/2022 Next Review Date ..................................... 01/01/2023 Administrative Policy Number ......................... A004 Preventive Care Services Table of Contents Administrative Policy ........................................ ......... 1 Wellness Examinations - General Description ........................................ .................. 3 Frequency of Wellness Examinations ................ 3 Preventive Care Services that may be provided during a Wellness Examination ........... 3 Preventive Care Screenings and Interventions (Note: some Services may be provided as part of a wellness examination or at a separate encounter).

The ordering of appropriate immunization(s) and laboratory/screening procedures Frequency of Wellness Examinations Ages 0 to age 5: According to the American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule 99381, 99382, 99391, 99392, 99461 Allowed with any diagnosis code Ages 5 and above: Annual wellness

  Schedule, Immunization