2020 preventive updates to Coverage Determination Guideline (CDG)

Upcoming updates to the Preventive Care Services CDG include HIV prevention and expanded women’s health prevention — expanded coding for lactation counseling, breast cancer prevention medications, and postpartum depression counseling.

Changes apply to UnitedHealthcare fully insured and self-funded customers that follow UnitedHealthcare’s standard preventive coverage. 

The UnitedHealthcare Preventive Care Services Coverage Determination Guideline (CDG) will include these updates on the effective date listed. This information is subject to change.

For more information, contact your UnitedHealthcare representative.  

2020 preventive updates to Coverage Determination Guideline (CDG)
Preventive CDG Change Description Effective Date
Pre exposure prophylaxis (PrEP) with effective antiretroviral therapy

USPSTF

Recommended for persons who are at high risk of HIV acquisition.

NY fully insured and NY non ERISA self-funded plans – Jan. 1, 2020

Other fully insured  and self-funded  plans – July 1, 2020

Breastfeeding and lactation counseling

New codes added 

98960, 98961, 98962

Also added several new diagnosis codes.

Jan. 1, 2020
Preventive counseling intervention for postpartum persons who are at increased risk of perinatal depression 

USPSTF

Counseling intervention for pregnant and postpartum persons who are at increased risk of perinatal depression.

Screening is already implemented 

Counseling  effective – Feb. 1, 2020

Risk reducing medications for women at risk for breast cancer

USPSTF

Recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

NY fully insured and NY non ERISA self-funded plans – Mar. 1, 2020  

All other fully insured and self-funded plans –  Oct. 1, 2020