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Clinical Guidelines
Clinical Practice Guidelines
Evidence-based clinical practice guidelines are developed to assist providers and members in making decisions about appropriate health care for specific clinical circumstances including “self-management” of chronic diseases. The guidelines are intended to improve the quality and consistency of care provided at the provider level. A physician champion is utilized in the development of these guidelines prior to the approval of each guideline by our Quality Management Committee and then they are disseminated to providers.
Adult and Child Preventive Screenings
Congestive Heart Failure (CHF)
Early Childhood Cavities Prevention (ECCP)
Pediatric Preventive Screenings
Preventive Care and Immunization Guidelines
These guidelines are comprised of recommendations from the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control (CDC):
Preventive Care Services Guidelines
Immunizations Guidelines
Below is a side-by-side comparison of the Welcome to Medicare Visit, Annual Wellness Visits, and Preventive Medicine Services codes. Samaritan Advantage Health Plan covers all of these codes (G0402, G0438, G0439, and 99381-99429). When billing SAHP with these codes, there is a $0.00 cost share to the Samaritan Advantage member. It is at the discretion of the provider to provide and code the appropriate level of a preventive comprehensive physical exam for the Medicare patient. Samaritan Health Plans encourages providers to conduct a full annual comprehensive exam (99381-99429).
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