Service Recommendation Adult men Adult Children Pregnant abdominal aortic aneurysm One-time screening by ultrasound in men aged 65 to 75 who have ever smoked Screening and counseling to reduce alcohol misuse Assessment of alcohol and drug use in adolescents the use of aspirin autism in the presence of bacteria in the urine for pregnant Behavioral assessments for high blood pressure Counseling related to BRCA (breast and ovarian cancer) screening Screening and behavioral counseling in primary care settings for adults, including pregnant Assessment for adolescents Men: Use of aspirin for men aged 45 to 79 years when the potential benefit of a reduction in heart attacks outweighs the potential harm of an increase in gastrointestinal hemorrhage Women: Use of aspirin for aged 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage at 18 and 24 months asymptomatic bacteriuria by urine culture for pregnant at 12 to 16 weeks' gestation or at first prenatal visit, if later Behavioral assessments for of all ages adults aged 18 and older Genetic counseling and evaluation for BRCA. Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes may be referred for genetic counseling and evaluation for BRCA testing Blue Cross and Blue Shield of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association C2032 (9/10) 1
Service Recommendation Adult men Adult Children Pregnant breast cancer conventional film screen mammography Screening mammography for, with or without clinical breast examination (CBE), every 1 2 years for aged 40 and older the chemo-prevention of breast cancer Discussion of potential benefits and harms of chemoprevention with at high risk for breast cancer and at low risk for adverse effects of chemoprevention Counseling to support breastfeeding cervical cancer (Pap test) Interventions during pregnancy and after birth to promote and support breastfeeding females who have been sexually active chlamydial infection abnormalities in all sexually active aged 24 and younger and for older who are at increased risk at higher risk of lipid disorders abnormalities: men 35 and older abnormalities: men younger than 35 men aged 35 and older for lipid disorders men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease abnormalities: 45 and older aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease 2
Service Recommendation Adult men Adult Children Pregnant abnormalities: younger than 45 aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease colorectal cancer Screening using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 and continuing until age 75 Prevention of tooth decay and cavities for preschool Oral fluoride supplementation by primary care physician for preschool older than 6 months of age whose primary water source is deficient in fluoride depression: adults Screening of adults when systems are in place to ensure accurate diagnosis, effective treatment, and follow-up depression: adolescents Screening of adolescents (12 18 years of age) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up Developmental screening for Developmental screening for under age 3, and surveillance throughout childhood diabetes a healthy diet type 2 diabetes in asymptomatic adults with sustained blood pressure (treated or untreated) greater than 135/80 mm Hg Intensive behavioral dietary counseling for adult patients with high and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians the use of folic acid supplementation For all planning or capable of pregnancy: daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid 3
gonorrhea Service Recommendation Adult men Adult Children Pregnant Screening of all sexually active, including those who are pregnant, if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors) Prophylactic medication for gonorrhea: newborns Prophylactic ocular topical medication for all newborns hearing loss hearing loss for newborn infants,, and adults Height, weight and body mass index measurements for hematocrit or hemoglobin in hemoglobinopathies Height, weight and body mass index measurements for sickle cell disease in newborns hepatitis B pregnant at their first prenatal visit HIV all adolescents and adults at increased risk for HIV infection congenital hypothyroidism Immunizations iron deficiency anemia newborns Immunization vaccines for and adults- -doses, recommended ages, and recommended populations vary pregnant 4
Service Recommendation Adult men Adult Children Pregnant Iron supplementation in Routine iron supplementation for asymptomatic aged 6 to 12 months who are at increased risk for iron deficiency anemia lead exposure in Medical history for at risk of exposure Medical history for all throughout development Screening and counseling for obesity: adults Screening of all adult patients and intensive counseling and behavioral interventions to promote sustained weight loss for obese adults Screening and counseling for obesity: Oral health risk assessment for Screening of aged 6 years and older and intensive behavioral interventions to promote improvement in weight status Assessment for young osteoporosis Ovarian cancer screening Routine screening for aged 65 and older. Routine screening beginning at age 60 for at increased risk for osteoporotic fractures. Ovarian cancer screening for at-risk. Includes CA125 and transvaginal ultrasound screenings phenylketonuria (PKU) newborns prostate cancer Prostate cancer screening for men aged 40 or over who are symptomatic or in a high-risk category and for all men aged 50 or older Rh incompatibility: first pregnancy visit Rh (D) blood typing and antibody testing for all pregnant during their first visit for pregnancy-related care 5
Service Recommendation Adult men Adult Children Pregnant Rh incompatibility: 24-28 weeks gestation Rh (D) antibody testing for all unsensitized Rh (D)-negative at 24 28 weeks' gestation, unless biological father is known to be Rh (D)- negative sexually transmitted infections (STIs) syphilis: non-pregnant persons High-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs Screening of persons at increased risk syphilis: pregnant Screening of all pregnant tobacco use Clinicians should ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products tobacco use: pregnant Clinicians should ask all pregnant about tobacco use and provide augmented, pregnancytailored counseling for those who smoke Testing for tuberculosis in visual acuity in Vision screening Testing for at higher risk of tuberculosis Screening to detect amblyopia, strabismus, and defects in visual acuity in younger than age 5 Vision screenings for and adults. Includes: Glaucoma Acuity Refraction 6