9 Clinical Trials ................................ ................................ ................................ ................................ ........... 43 Dental Services ................................ ................................ ................................ ................................ ....... 44 Preparing the Mouth for Medical Treatments ................................ ................................ ...................... 44 Treatment of Accidental Injury ................................ ................................ ................................ ............. 44 Anesthesia and Hospital Charges for Dental Care ................................ ................................ .............. 44 Diabetes Equipment, Education, and Supplies ................................ ................................ ....................... 45 Diagnostic Services ................................ ................................ ................................ ................................ . 45 Diagnostic Laboratory and Pathology Services ................................ ................................ ................... 45 Diagnostic Imaging Services and Electronic Diagnostic Tests ................................ ............................ 45 Advanced Imaging Services ................................ ................................ ................................ ................ 45 Dialysis ................................ ................................ ................................ ................................ .................... 46 Durable Medical Equipment (DME), Medical Devices, and Supplies ................................ .................. 46 Orthotics ................................ ................................ ................................ ................................ ............... 46 Prosthetics ................................ ................................ ................................ ................................ ........... 46 Prosthetic Limbs & Orthotic Custom Fabricated Brace or Support ................................ ..................... 47 Medical and Surgical Supplies ................................ ................................ ................................ ............. 47 Blood and Blood Products ................................ ................................ ................................ ................... 48 Emergency Care Services ................................ ................................ ................................ ....................... 48 Emergency Services ................................ ................................ ................................ ............................ 48 Habilitative Services ................................ ................................ ................................ ................................ 49 Home Health Care Services ................................ ................................ ................................ .................... 49 Home Infusion Therapy ................................ ................................ ................................ ........................... 50 Hospice Care ................................ ................................ ................................ ................................ ........... 50 Human Organ and Tissue Transplant (Bone Marrow / Stem Cell) Services, Cellular and Gene Therapy Services ................................ ................................ ................................ ................................ ................... 50 Prior Approval and Precertification ................................ ................................ ................................ ...... 51 Inpatient Services ................................ ................................ ................................ ................................ .... 52 Inpatient Hospital Care ................................ ................................ ................................ ........................ 52 Inpatient Professional Services ................................ ................................ ................................ ........... 53 Maternity and Reproductive Health Services ................................ ................................ .......................... 53 Maternity Services ................................ ................................ ................................ ............................... 53 Contraceptive Benefits ................................ ................................ ................................ ......................... 54 Sterilization Services ................................ ................................ ................................ ............................ 54 Infertility Services ................................ ................................ ................................ ................................ . 54 Mental Health and Substance Use Disorder Services ................................ ................................ ............ 55 Occupational Therapy ................................ ................................ ................................ ............................. 55 Office and Home Visits ................................ ................................ ................................ ............................ 55 Orthotics ................................ ................................ ................................ ................................ .................. 56 Outpatient Facility Services ................................ ................................ ................................ ..................... 56 Physical Therapy ................................ ................................ ................................ ................................ ..... 56 Preventive Care ................................ ................................ ................................ ................................ ....... 56 Preventive Care for Chronic Conditions (per IRS guidelines) ................................ ................................ . 58 Prosthetics ................................ ................................ ................................ ................................ ............... 58 Pulmonary Therapy ................................ ................................ ................................ ................................ . 58 Radiation Therapy ................................ ................................ ................................ ................................ ... 58 Rehabilitation Services ................................ ................................ ................................ ............................ 58 Respiratory Therapy ................................ ................................ ................................ ................................ 58 Skilled Nursing Facility ................................ ................................ ................................ ............................ 59 Smoking Cessation ................................ ................................ ................................ ................................ .. 59 Speech Therapy ................................ ................................ ................................ ................................ ...... 59 Surgery ................................ ................................ ................................ ................................ .................... 59 Oral Surgery ................................ ................................ ................................ ................................ ......... 59 Reconstructive Surgery ................................ ................................ ................................ ........................ 59 Temporomandibular Joint (TMJ) and Craniomandibular Joint Services ................................ ................. 60 Therapy Services ................................ ................................ ................................ ................................ ..... 60 Physical Medicine Therapy Services ................................ ................................ ................................ ... 60