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Preventive Care Reminder Sent to Members
Effective date
Dec 1, 2026
Identified
Jul 1, 2026
Summary
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
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What to do
Action · 13 steps
01Future transition 12/01/2026: For pregnancy services, use the diagnosis codes added to the Pregnancy table, which applies to all services marked with the fetal health symbol.
02Billing team: after 09/01/2026, bill an evaluation and management code when providing obstetric professional care and append modifier -TH to the E/M code to differentiate the maternity visits.
03For codes marked *+, put an eligible Z30-family diagnosis code in the primary diagnosis position.
04For codes marked *^, zero-cost benefits do not apply when the member has a Consumer-Directed Health Plan or belongs to certain ASO groups, and those codes are eligible only with diagnosis codes Z30.09 and Z30.2.
05Get prior approval where marked: prior approval is required for monitored anesthesia care with a screening colonoscopy (CPT 00812), and may be required for low-dose CT lung screening (71271) and BRCA risk assessment and genetic testing.
06Breast MRI may require prior approval, and the prior approval requirements are at https://www.bluecrossvt.org/providers/prior-approval-authorization.
07Bill CPT 36415 or 36416 for a blood draw needed for a preventive lab, which is also eligible at no cost.
08Indicate vaccine administration codes as appropriate.
09For colorectal cancer screening, the screening diagnosis goes in the primary position and the disease-specific condition in the secondary position.
10Diabetes and atherosclerosis diagnosis codes are eligible only when paired with the procedure codes in the Healthy Diet and Physical Activity section.
11For PrEP, once a generic becomes available, zero-cost coverage applies only to the generic form.
12Already effective 10/01/2026: Branded oral contraceptives can be dispensed only when no commercially available generic equivalent exists, and otherwise oral contraceptives are covered for generic only.
13Claim editing logic applies and supersedes all coding listed in this policy.
Codes mentioned
7127119030770467704777048770497705377054770617706277063770657706677067766417664282947829508295183036453908749490481904829048390484J729900840J0738J0752G0270G0271G0537R73.03008123641536416O09.00O09.211O09.291O09.292O09.293O09.299O09.30O09.33O09.511O09.611O09.621O09.819O09.90O09.91O09.92O09.93594005942559426595105961059618
Original notice
Preventive Care Reminder Sent to Members
bluecrossvt.org · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Vermont changes →Contraceptive Counseling ReminderHighNo effective date · Provider NewsCMO Corner: Important Changes to Global Maternity Care Coding and BillingHighEffective Jan 1, 2027 · CodingNutritional Therapy and Nutritional CounselingMediumEffective Aug 1, 2026 · NewsletterChanges to Global Maternity Care and Delivery CodingHighEffective Sep 1, 2026 · CodingBrowse every Blue Cross Blue Shield of Vermont change in the policy list
Related policy hubs
Blue Cross Blue Shield of Vermont policiesVT policy changesFamily MedicineInternal MedicinePediatricsOB-GYNPharmacyCode 71271Code 19030Code 77046Code 77047Code 77048Code 77049Code 77053Code 77054Code 77061Code 77062Code 77063Code 77065Code 77066Code 77067Code 76641Code 76642Code 82947Code 82950Code 82951Code 83036Code 45390Code 87494Code 90481Code 90482Code 90483Code 90484Code J7299Code 00840Code J0738Code J0752Code G0270Code G0271Code G0537Code R73.03Code 00812Code 36415Code 36416Code O09.00Code O09.211Code O09.291Code O09.292Code O09.293Code O09.299Code O09.30Code O09.33Code O09.511Code O09.611Code O09.621Code O09.819Code O09.90Code O09.91Code O09.92Code O09.93Code 59400Code 59425Code 59426Code 59510Code 59610Code 59618