9 Preparing the Mouth for Medical Treatments ......................................................................................40 Treatment of Accidental Injury .............................................................................................................40 Anesthesia and Hospital Charges for Dental Care..............................................................................40 Diabetes Equipment, Education, and Supplies .......................................................................................40 Diagnostic Services .................................................................................................................................41 Diagnostic Laboratory and Pathology Services...................................................................................41 Diagnostic Imaging Services and Electronic Diagnostic Tests............................................................41 Advanced Imaging Services ................................................................................................................41 Dialysis ....................................................................................................................................................41 Durable Medical Equipment (DME), Medical Devices, and Supplies..................................................41 Orthotics...............................................................................................................................................42 Prosthetics ...........................................................................................................................................42 Prosthetic Limbs & Orthotic Custom Fabricated Brace or Support .....................................................43 Medical and Surgical Supplies.............................................................................................................43 Blood and Blood Products ...................................................................................................................43 Emergency Care Services.......................................................................................................................43 Emergency Services............................................................................................................................43 Gender Affirming Services.......................................................................................................................45 Habilitative Services ................................................................................................................................45 Home Health Care Services....................................................................................................................45 Home Infusion Therapy ...........................................................................................................................46 Please see “Therapy Services” later in this section. ...............................................................................46 Hospice Care...........................................................................................................................................46 Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services, Cellular and Gene Therapy Services...................................................................................................................................................46 Prior Approval and Precertification .................................................................................................47 Infertility Services ....................................................................................................................................48 Inpatient Services ....................................................................................................................................48 Inpatient Hospital Care ........................................................................................................................48 Inpatient Professional Services ...........................................................................................................49 Maternity and Reproductive Health Services ..........................................................................................49 Maternity Services ...............................................................................................................................49 Contraceptive Benefits.........................................................................................................................50 Sterilization Services............................................................................................................................51 Infertility Services.................................................................................................................................51 Mental Health and Substance Use Disorder Services ............................................................................51 Occupational Therapy .............................................................................................................................51 Please see “Therapy Services” later in this section. ...............................................................................51 Orthotics ..................................................................................................................................................52 Outpatient Facility Services.....................................................................................................................52 Physical Therapy .....................................................................................................................................52 Please see “Therapy Services” later in this section. ...............................................................................52 Preventive Care.......................................................................................................................................52 Preventive Care for Chronic Conditions (per IRS guidelines) .................................................................54 Prosthetics...............................................................................................................................................54 Pulmonary Therapy .................................................................................................................................54 Please see “Therapy Services” later in this section. ...............................................................................54 Radiation Therapy ...................................................................................................................................54 Please see “Therapy Services” later in this section. ...............................................................................54 Rehabilitation Services............................................................................................................................54 Respiratory Therapy ................................................................................................................................55 Please see “Therapy Services” later in this section. ...............................................................................55 Skilled Nursing Facility ............................................................................................................................55 Smoking Cessation..................................................................................................................................55 Speech Therapy ......................................................................................................................................55 Please see “Therapy Services” later in this section. ...............................................................................55