USPSTF grades explained: what A, B, C, D and I mean

What the USPSTF is

The USPSTF was created in 1984. It describes itself as a scientifically independent, volunteer panel of national experts in prevention and evidence-based medicine. Its members come from primary care fields such as family and internal medicine, pediatrics, obstetrics and gynecology, behavioral health and nursing. (USPSTF, About)

There are 16 volunteer members, appointed by the Secretary of Health and Human Services (HHS) for 4-year terms and screened for conflicts of interest. (USPSTF, Our Members) Since 1998 the Agency for Healthcare Research and Quality (AHRQ) has been authorized by Congress to convene the Task Force and give it scientific, administrative and dissemination support. (USPSTF, About)

Three limits are worth knowing. The recommendations apply only to people without signs or symptoms of the condition. They cover services offered in, or referred from, primary care. And the USPSTF does not consider cost when it sets a grade. (USPSTF, About)

The five grades in plain words

The grade combines two things: how large the net benefit is (benefits minus harms), and how certain the USPSTF is about it. (USPSTF grade definitions)

USPSTF grades, what they mean and examples on this site
Grade	What it means	USPSTF suggestion	Examples on this site
A	Recommended. High certainty that the net benefit is substantial.	Offer or provide it.	Blood pressure, colorectal cancer 50 to 75, HIV, folic acid, quit-smoking help
B	Recommended. High certainty of a moderate net benefit, or moderate certainty of a moderate to substantial one.	Offer or provide it.	Mammogram 40 to 74, lung cancer, bone density, statins, exercise to prevent falls
C	Offer it selectively, to some people, based on professional judgment and the patient's preferences. At least moderate certainty that the net benefit is small.	Offer it to selected patients, depending on their circumstances.	PSA at 55 to 69, colorectal cancer 76 to 85, aspirin at 40 to 59, sun-protection advice after 24
D	Recommended against. Moderate or high certainty that there is no net benefit, or that the harms outweigh the benefits.	Discourage it.	PSA from 70, starting aspirin at 60 or older, ovarian, testicular and other tests
I statement	The evidence is lacking, of poor quality or conflicting, so benefits and harms cannot be weighed.	Read the clinical considerations; if offered, the patient should understand the uncertainty.	Skin checks, mammogram from 75, hearing and vision, vitamin D test

Grade definitions: USPSTF, in use for recommendations voted on after July 2012. (USPSTF grade definitions) Each example page cites its own USPSTF statement and date.

A grade belongs to a group of people, not to a test. The same test can carry different grades by age: colorectal screening is grade A at 50 to 75 and grade C at 76 to 85, and the PSA test is grade C at 55 to 69 and grade D from 70. That is why this site shows screenings by age.

Grade C decisions depend most on your values and circumstances. The USPSTF says deciding whether to offer one to a given person will usually need an informed conversation between the clinician and the patient. (USPSTF grade definitions)

How sure is "certain"?

The USPSTF rates its certainty as high, moderate or low. High means consistent results from well-designed studies in primary care populations, so future studies are unlikely to change the conclusion. Moderate means the evidence is enough to judge, but limits such as few or small studies mean the conclusion could change. Low means the evidence is not enough to judge, which leads to an I statement. (USPSTF grade definitions)

How a draft becomes final

Each recommendation goes through three stages, and the public can comment on each draft for 4 weeks. (USPSTF, Public Comment)

Research plan. A few Task Force members, the topic leads, work with researchers at an Evidence-based Practice Center to set the questions and the literature search. The draft plan is posted for comment, revised, and posted as final.
Evidence review. The researchers review the studies, present a draft review to the full Task Force, and post it for comment and for review by outside experts. It is then finalized.
Recommendation statement. The full Task Force weighs benefits and harms and sets the grade. The topic leads write a draft statement, which is posted for comment. After revision, the full Task Force votes on the final statement and posts it.

Until a final statement is published, the USPSTF treats the statement already on its website as current. (USPSTF, Public Comment) This site does the same: where a draft update exists, as for cervical cancer screening, we keep the final statement and label the draft "draft, not final". See Method.

What A and B grades mean for insurance

Under the Affordable Care Act, group health plans and health insurers must cover services with a current USPSTF A or B rating without cost sharing such as copays or coinsurance. The law requires a gap of at least 1 year between a new recommendation and the plan year it applies to. (42 U.S.C. 300gg-13) HealthCare.gov notes that this generally means an in-network provider and that $0 cost is not guaranteed in all cases. (HealthCare.gov) Grades C, D and I carry no such requirement.

On June 27, 2025, the Supreme Court held that Task Force members are validly appointed by the HHS Secretary, reversing a lower court ruling that had found their appointment unconstitutional. The Court noted that the Secretary can remove members at will and can review and block recommendations before they take effect. (Supreme Court, 2025)

Which screenings HealthCare.gov and Medicare list one by one: preventive screenings covered by insurance and Medicare. The full USPSTF A and B list: (USPSTF A and B list)

Questions people ask

What is the difference between a grade A and a grade B?

Both mean the USPSTF recommends the service and suggests offering it. Grade A means high certainty that the net benefit is substantial. Grade B means high certainty of a moderate net benefit, or moderate certainty of a moderate to substantial one. For you, both are screenings to ask about at the right age. (USPSTF grade definitions)

Does grade D mean a test is dangerous?

Not dangerous in itself. Grade D means the USPSTF recommends against routine use for people without symptoms, because it is moderately or highly certain there is no net benefit or that the harms, such as false alarms and follow-up procedures, outweigh the benefits. If you have symptoms or your doctor has a reason, the D grade does not apply. (USPSTF grade definitions) (USPSTF, About)

What does an I statement mean?

That the evidence is lacking, of poor quality or conflicting, so the USPSTF cannot weigh benefits against harms. It is not a recommendation for or against. If the service is offered, the USPSTF says patients should understand that the balance is uncertain. (USPSTF grade definitions)

Does the USPSTF consider cost?

No. The USPSTF says it does not consider the cost of a preventive service when it sets a grade. (USPSTF, About)

Do I pay for a grade A or B screening?

Under the Affordable Care Act, most private health plans must cover A and B services without cost sharing. HealthCare.gov adds that this generally means an in-network provider, and that $0 cost is not guaranteed in all cases. Ask your plan before the visit. (42 U.S.C. 300gg-13) (HealthCare.gov)

Is a draft recommendation already in effect?

No. The USPSTF says that until the final statement is published, the statements on its website are the current ones. A draft can still change after public comment. (USPSTF, Public Comment)