Reminder: Annual physical and associated lab services

As you’ve read before, Blue Cross Blue Shield of Michigan must fully cover specific preventive services under the Affordable Care Act.

Examples of preventive services are those that are included in annual exams, such as annual physical exams (sometimes called health maintenance exams) and associated lab services. There are certain lab services, such as vitamin D and vitamin B12 testing, that are not covered as preventive when ordered as part of the annual physical. Ordering these can result in cost to the member. Only tests that are classified as category “A or B” under the United States Preventive Services Task Force are routinely covered under an annual exam.

Here are more details about these two tests that aren’t covered when performed in the context of an annual exam:

• Vitamin D screening — The United States Preventive Services Task Force  concludes that the current evidence is insufficient to assess the balance of benefit and harm of screening for vitamin D deficiency in asymptomatic adults. As such, Blue Cross doesn’t cover vitamin D lab as preventive when ordered during the annual physical.
• Vitamin B12 screening — No major medical organizations, including the USPSTF, have published guidelines on screening asymptomatic or low-risk adults for vitamin B12.

A list of preventive service codes with no member cost sharing is posted on web-DENIS. Here’s how to find it:

• Click on Newsletters and Resources.
• Click on Health Reform Information.

How can you help?

• Let your patients know that your practice orders tests in alignment with current clinical practice guidelines. This helps to minimize patient confusion, control out-of-pocket costs and ensure that patients receive appropriate care while avoiding unnecessary tests.
• If you decide during an annual exam that vitamin D or B12 testing is necessary, based on the patient’s symptoms and exam results, be sure to bill it with the appropriate diagnosis code. The member should be counseled on the possibility that they will incur out-of-pocket costs associated with the testing.

We value our provider partners in helping us to improve patient experience and ensure that all care delivery is necessary and appropriate.

None of the information included herein is intended to be medical advice.