38 Coverage is provided for the treatment of autism spectrum disorders. Treatment is limited to services prescribed by your Physician in accordance with a treatment plan. Autism spectrum disorder means a neurological condition, including Asperger's syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Any exclusion or limitation in this Booklet in conflict with the coverage described in this provision will not apply. Coverage for autism spectrum disorders will not be subject to dollar limits, Deductibles, Copayment or Coinsurance provisions that are less favorable than the dollar limits, Deductibles, Copayments or Coinsurance provisions that apply to physical illness under your Plan. Behavioral Health Services Please see “Mental Health and Substance Use Disorder Services” later in this section. Biomarker Testing Services This Plan provides coverage for biomarker testing when ordered by a qualified health care provider’s scope of practice for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of a Member’s disease or condition when the test is supported by medical and scientific evidence, including but not limited to: • Labeled indications from an FDA-approved or cleared test; • Indicated tests for an FDA-approved Drug; • Warnings and precautions on FDA-approved Drug labels; • Centers for Medicare and Medicaid Services national coverage determinations; • Medicare Administrative Contractor local coverage determinations; • Nationally recognized clinical practice guidelines; or Consensus statements. Cardiac Rehabilitation Please see “Therapy Services” later in this section. Cellular and Gene Therapy Services Standard: Your Plan includes benefits for certain cellular and gene therapy services, when Anthem approves the benefits in advance through Precertification. See the section “Human Organ and Tissue Transplant (Bone Marrow / Stem Cell), Cellular and Gene Therapy Services” for additional details. Chemotherapy Please see “Therapy Services” later in this section. Chronic Pain Management Services Evidence based health care products and services intended to relieve chronic pain that has lasted for at least three (3) months are covered under this Plan. This includes: • Prescription drugs; • Physical Therapy; • Occupational Therapy;
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