Preventive services include periodic health screenings or assessments, and are not directly related to a specific illness, injury or set of symptoms. Treatment or monitoring of a medical condition (for example, diabetes or hypertension) is not considered preventive.
Health Promotion and Disease Prevention Examinations
Health promotion and disease prevention (HP&DP) examinations are covered if one of the following preventive services is ordered or rendered during the visit:
- a covered immunization
- cervical cancer screening, for example, Pap smear, also known as Pap test
- breast cancer screening, for example, mammogram
- colorectal cancer screening
- prostate cancer screening
Health promotion and disease prevention exam claims usually include a general medical examination diagnosis (V70 or V70.0). A separate diagnosis code for an immunization, screening Pap test, breast cancer screening, colorectal cancer screening, or prostate cancer screening is required for claims payment. See the individual services for frequency of coverage.
In addition to the above, TRICARE Prime and TRICARE Select beneficiaries (when using a network provider), ages six years and older may receive one HP&DP exam annually without one of the clinical preventive services above. While often rendered by a primary care manager, HP&DP exams and accompanying immunizations and screenings may be performed by any other network provider within the beneficiary's region of enrollment without a referral.
Note: If a cancer screening or immunization is not performed or ordered during a HP&DP exam outside of the one allowance per year for TRICARE Prime and TRICARE Select beneficiaries (when using a network provider) as noted above, the preventive exam may not be covered.
Other Preventive Services May Include:
The following additional cancer screenings may be performed during any covered office visit (reimbursement is included in that office visit):
- testicular cancer screening
- skin cancer screening
- oral cavity and pharyngeal cancer screening
- thyroid cancer screening