9 Dental Services .........................................................................................................................................42 Preparing the Mouth for Medical Treatments ........................................................................................42 Treatment of Accidental Injury ...............................................................................................................42 Anesthesia and Hospital Charges for Dental Care................................................................................42 Diabetes Equipment, Education, and Supplies .........................................................................................42 Diagnostic Services ...................................................................................................................................43 Diagnostic Laboratory and Pathology Services.....................................................................................43 Diagnostic Imaging Services and Electronic Diagnostic Tests..............................................................43 Advanced Imaging Services ..................................................................................................................43 Dialysis ......................................................................................................................................................43 Durable Medical Equipment (DME), Medical Devices, and Supplies....................................................44 Orthotics.................................................................................................................................................44 Prosthetics .............................................................................................................................................44 Prosthetic Limbs & Orthotic Custom Fabricated Brace or Support .......................................................45 Medical and Surgical Supplies...............................................................................................................45 Blood and Blood Products .....................................................................................................................45 Emergency Care Services.........................................................................................................................45 Emergency Services..............................................................................................................................46 Habilitative Services ..................................................................................................................................47 Home Health Care Services......................................................................................................................47 Home Infusion Therapy .............................................................................................................................47 Hospice Care.............................................................................................................................................47 Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services, Cellular and Gene Therapy Services.....................................................................................................................................................48 Prior Approval and Precertification............................................................................................................49 Inpatient Services ......................................................................................................................................50 Inpatient Hospital Care ..........................................................................................................................50 Inpatient Professional Services .............................................................................................................51 Maternity and Reproductive Health Services ............................................................................................51 Maternity Services .................................................................................................................................51 Contraceptive Benefits ..............................................................................................................................52 Sterilization Services .................................................................................................................................52 Infertility Services ......................................................................................................................................52 Mental Health and Substance Use Disorder Services ..............................................................................52 Occupational Therapy ...............................................................................................................................53 Office and Home Visits..............................................................................................................................53 Orthotics ....................................................................................................................................................54 Outpatient Facility Services.......................................................................................................................54 Physical Therapy .......................................................................................................................................54 Preventive Care.........................................................................................................................................54 Preventive Care for Chronic Conditions (per IRS guidelines) ...................................................................56 Prosthetics.................................................................................................................................................56 Pulmonary Therapy ...................................................................................................................................56 Radiation Therapy .....................................................................................................................................56 Rehabilitation Services..............................................................................................................................56 Respiratory Therapy ..................................................................................................................................56 Skilled Nursing Facility ..............................................................................................................................56 Smoking Cessation....................................................................................................................................57 Speech Therapy ........................................................................................................................................57 Surgery ......................................................................................................................................................57 Oral Surgery...........................................................................................................................................57 Reconstructive Surgery..........................................................................................................................58 Temporomandibular Joint (TMJ) and Craniomandibular Joint Services ...................................................58 Therapy Services.......................................................................................................................................58 Physical Medicine Therapy Services .....................................................................................................58 Other Therapy Services.........................................................................................................................59