2020 preventive updates to Coverage Determination Guideline (CDG)
- All States
- Fully Insured and Self-Funded
- Legal and Compliance
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.
|Preventive CDG Change||Description||Effective Date|
|Pre exposure prophylaxis (PrEP) with effective antiretroviral therapy||
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||
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||
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