Changes to Highmark’s 2022 Preventive Health Guidelines

Below is a list of all changes that were made to Highmark’s Preventive Health Guidelines for the year 2022.

  • Expanded Benefit: Colon Cancer Screening – lowered eligible age from 50 to 45 for general population colon cancer screening as well as Certain Colonoscopy Preps: On May 18, 2021, the United States Preventive Services Task Force (USPSTF) released a final statement for lowering the age of colorectal cancer screenings from 50 to 45 years of age. The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.

  • Expanded Benefit: Lung Cancer Screening – lowered eligible age from 55 to 50 and pack per year (PPY) from 30 to 20: The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 PPY smoking history and are currently smoking or have quit smoking within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)

  • Expanded Benefit: PrEP Drugs: Certain Related Services for PrEP drug use were added under Select Drugs Requiring Prescription. An FAQ was released with guidance for first dollar coverage of related services to PrEP drug usage. Additionally, cost sharing no longer applies as of effective date 9.17.2021 per federal law. The Provider Resource Center – Preventive Health Guidelines Section - contains the list of procedures/testing that is included in first dollar coverage.

  • New Benefit: Nutritional counseling for pregnant women to promote healthy weight during the pregnancy: On May 25, 2021, the USPSTF released a recommendation that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. As such, nutritional counseling for pregnant women has been added to the preventive schedule. (B recommendation)

  • Depression Screening: To align with Bright Futures and the USPSTF, depression screening to begin at age 12, not age 11. Preventive schedule language updated to read “once a year, age 12-18”.

  • Hepatitis C Screening: Beginning age 18: “High Risk” recommendation was removed from the preventive schedule and a single dot added to age 18 per Bright Futures update to align with USPSTF recommendations for screening beginning at this age.

Reviewing Highmark’s Preventive Health Guidelines

To access the Preventive Health Guidelines on the Provider Resource Center, select EDUCATION/MANUALS, and then click on Preventive Health Guidelines.

We encourage you to consult our Preventive Health Guidelines and discuss them with members when planning care.   

NOTE: Most, although not all, Highmark members have coverage for services on the preventive schedule. To verify that the member is covered for a preventive health screening, use the Eligibility and Benefits transaction in NaviNet® to perform an electronic HIPAA 270 Eligibility/Benefit Inquiry transaction, or call the Provider Service Center.

 

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